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.

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.

Clinical Criteria for all injectable, infused or implanted prescription drugs and therapies covered under the medical benefit