Utilization management authorization requirements
Refer to the Utilization management authorization requirements (PDF) to learn more about benefits and services that require prior authorization.

Use the Utilization management authorization request form (PDF) to submit for prior, concurrent or retrospective review authorization requests.

Explanation of benefit codes
Refer to the Blue Cross Complete explanation of benefit codes (PDF) for new and current EOB codes.

Genetic testing codes
The Genetic Testing Codes (PDF) tells you which genetic testing codes require prior authorization.

Pharmacy reference guide
Refer to the Pharmacy Reference Guide (PDF) for a quick reference about pharmacy provider services, prior authorizations, member copays, durable medical equipment covered under pharmacy and recipient restrictions.

Claims filing instructions
The Claims Filing Instructions Manual (PDF) guides you through submitting clean claims to Blue Cross Complete.

The Appropriate Use of Claims Modifier Guide (PDF) helps you with billing using modifier 25 and 59 appropriately.

Submitting a refund
Use the Provider Claim Refund Form (PDF) to submit a refund of overpayment to Blue Cross Complete.

Dual-eligible members
Dual-eligible members (PDF)
Learn how to serve dual-eligible members who qualify for both Medicare and Medicaid.

HEDIS handbook
The Blue Cross Complete HEDIS Supplemental Data Exchange provider handbook (PDF) provides an explanation of our data exchange processes and how we identify the necessary clinical data for closing gaps in care for our members.