Provider Manuals And Guides
Healthy Blue is committed to supporting you in providing quality care and services to the members in our network. Here, you will find information for assessing coverage options, guidelines for clinical Utilization Management (UM), practice policies and support for delivering benefits to our members.
Provider Manual
The Healthy Blue provider manual provides key administrative information, including the quality improvement program, the UM program, quality standards for participation, claims appeals, and reimbursement and administration policies.
- Provider Manual
- Provider Quick Reference Guide
- Centers of Medical Excellence Transplant Operations Manual
- Provider Digital Engagement Supplement
Medical Policies And Clinical UM Guidelines
Medical Policies address the medical necessity of new services or procedures and new applications of existing services or procedures. Clinical UM Guidelines focus on detailed selection criteria, goal length of stay, and location for generally accepted technologies or services.
Medical Policies And Clinical UM Guidelines
- Clinical Utilization Management Guidelines
- February 2021 Clinical Utilization Management (UM) Guidelines
- May 2021 Clinical Utilization Management (UM) Guidelines
- August 2021 Clinical Utilization Management (UM) Guidelines
- November 2021 Clinical Utilization Management (UM) Guidelines
- May-August 2022 Clinical Utilization Management Guidelines
- Clinical Utilization Management Criteria February 2023
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
- Referrals
- Forms
- Training Academy
- Pharmacy Information
- Electronic Data Interchange (EDI)
- Quality of Care Form