Providers
Blue Medicare
Access plan information for Blue Medicare HMO℠, PPO℠, and Healthy Blue + Medicare℠ (HMO-POS D-SNP), including coverage details, guidelines, and resources for providers.
Plans and programs
Find plan details and explore programs designed to support patient health and quality of care.
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Healthy Blue + Medicare (HMO-POS D-SNP)
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View D-SNP resources, training, and contact information.
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Case management programs
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View documentation for coding diagnoses and services.
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Quality improvement program
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Learn more about how we aim to maintain the highest quality of treatment for our Blue Medicare members.
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Prior authorization and coding
Some procedures and drugs require prior authorization, but not all procedures and services appear in the CPT search. Check Medicare guidelines for additional details.
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Services and CPT codes
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Search by CPT or HCPCS code to check if a procedure requires prior authorization.
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Prescription drugs
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Review information on prescription drug coverage and search by drug name to check if it requires prior authorization.
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Additional request forms
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Some forms are available in our resource hub for requesting prior authorization.
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Policies and guidelines
Explore medical and reimbursement policies, administrative guidelines, and the hold harmless policy to ensure compliance and proper billing.
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Medical policies
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Review medical policies to understand coverage criteria and clinical guidelines.
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Reimbursement policies
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Understand reimbursement rules, payment guidelines, and billing requirements for covered services.
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Hold harmless policy
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Some Blue Medicare members will not be held financially responsible for covered services under certain conditions.
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Risk adjustment
Risk adjustment coding can be complex. We offer educational guides and videos to help providers and their teams accurately code for chronic and complicated conditions.
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Hierarchical Condition Category (HCC) risk adjustment coding & documentation
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Find resources to code, including ICD‑10 guidelines, documentation tips, and provider education.
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