Transcription of Provider Communications Administration Manual
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Provider Communications Administration Manual
Provider Administration ManualRevised June 2018 BlueCross BlueShield of Tennessee Provider Administration Manual i TABLE OF CONTENTS I. INTRODUCTION A. BlueCross BlueShield of Tennessee Statement of Purpose B. Descriptions of Networks C. Individual Product and Plan Options D. Health Insurance Portability and Accountability Act of 1996 (HIPAA) 1. Health Information Privacy Policies and Procedures 2. Protected Health Information-allowable disclosures under HIPAA E. General Information 1. Fraud and Abuse Hotline 2. Interpretation Services 3. Provider Communications 4. Pre-existing Condition II. BLUECROSS BLUESHIELD OF TENNESSEE QUICK REFERENCE TELEPHONE GUIDE III. HOW TO IDENTIFY A BLUECROSS BLUESHIELD MEMBER A. Identifying a Member s ID Card B.
2. Miscellaneous, Non-Specific and Not Otherwise Classified (NOC) Procedures/Services (Refer to “How to File a Claim” in this section for billing information) 3. Code Edits 4. Modifiers 5. Qualitative Drug Screen Testing 6. Reimbursement Policy for Serious Reportable Adverse Events (Never Events) 7. Final Reimbursement 8.
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