We are committed to supporting you in providing quality care and services to the members in our network. Here you will find frequently used forms, PDFs, provider manuals and guides, prior authorization information, practice policies, and support for delivering benefits to our members.
Provider forms are located in our online library for easy access.
Healthy Blue offers training and tutorials to support providers in continuing their education. Presentations, videos and other training documentation will be added as they become available.
Policies, Guidelines And Manuals
Healthy Blue policies, guidelines and manuals provide key administrative information such as:
- Quality improvement program
- Quality standards for participation
- Claims appeals
- Reimbursement and administration policies
Learn about Availity
Many of the tools you need — such as eligibility and benefits inquiry, claims submission, claims status inquiry, and authorizations — can now be accessed by logging into your account on Availity.
Healthy Blue makes determinations based on selected inpatient or outpatient medical services including surgeries, major diagnostic procedures and referrals to validate medical necessity.
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
Healthy Blue’s behavioral health provider network includes psychiatrists, psychologists, social workers, psychiatric nurses, and other mental health and employee assistance health care professionals. Our facility network includes hospital inpatient units, residential treatment centers, partial hospitalization programs, and intensive outpatient services and programs.
Provider Tools & Resources
- Log In To Availity
- Launch Provider Learning Hub Now
- Learn About Availity
- Prior Authorization Lookup Tool
- Prior Authorization Requirements
- Claims Overview
- Member Eligibility & Pharmacy Overview
- Policies, Guidelines & Manuals
- Training Academy
- Pharmacy Information
- Electronic Data Interchange (EDI)
- Quality of Care Form