• Communications

• Policies and Guidelines

• Claims and Billing

• National Provider Identifier (NPI)
• ICD-10
• Electronic Data Interchange (EDI) Services
• BlueCard
• Private Fee-for-Service
• Claims Requirements and Communications
• Claims Submission Addresses
• Claims Requiring Submission of Clinical Information
• Chiropractic Billing Guide
• Clear Claim Connection and Significant Edits Disclosure Report

• Interactive Tools and Resources

• Pharmacy Information

• Resources for Patient Management

• Physician Advisory Committee

• Contact Information

Private Fee-for-Service

As a provider, you can access a PFFS plan finder, terms and conditions, and payment and reimbursement information.

Select Advantage Terms and Conditions

Payment Methodology Information

Reimbursement Grid

Plan Finder

To view Terms and Conditions for out-of-area beneficiary’s home plan, go to the Plan Finder.

Forms

• Notice of Medicare Non-coverage (NOMNC) form
• Detailed Explanation of Non-coverage (DENC) form
• Notice of Discharge and Medicare Appeal Rights (NODMAR) form
• Provider Appeals form