Providers
Medical Providers
Provider Manual
Your source for commonly asked questions about healthcare coverage, claims procedures, policies and more.
View Provider ManualCoverage policy
Quickly search for coverage information using a keyword, procedure code, policy number or title.
View coverageInterQual® Coverage Policy Guidelines
The InterQual® guidelines are used by our utilization management team to help assess whether a given medical condition and known or represented circumstances of a case support medical service(s) as the most appropriate treatment, or whether the medical condition/circumstances presented could be appropriately addressed with an alternative treatment. Use the self-registration tool at the link to create a login and view the criteria. Individuals without an email address should contact the plan to receive the criteria information via mail.
View guidelinesProviders' News
Find updates on the latest policies and procedures for providers.
Read Providers' NewsCoverage policy and pre-certification/pre-authorization
Coverage policy and pre-certification/pre-authorization information for out-of-area members.
View coverage policyPrior authorization information for radiological services
Information to assist providers in filing claims, referral requests and other services.
View morePrior authorization information for medical oncology drugs
Information for providers on requesting prior authorization for medical oncology drugs.
Learn more about prior authorization information for medical oncology drugsPrior authorization information for step therapy protocol exception
Information for providers on an exception request process for drugs identified by the health plan as subject to step therapy.
View processPrior authorization guide for Metallic policies
Use this guide to see prior authorization information for members with ID card prefixes: AEE, AXC, EXX, XCB, XCQ, XCR
View guidesRadiology utilization for Arkansas Blue Cross FEP
Carelon Medical Benefits Management ® to manage radiology utilization for Arkansas Blue Cross FEP
About FEP program