Support Care Coordination After Hospital Discharges

When our members receive inpatient hospital care, hospital care teams can help coordinate care with primary care providers by sharing discharge summaries. View tips to support care coordination.

We’re Removing Option To Request Recommended Clinical Review for Medical Necessity

To improve the efficiency of our utilization management program, we’ll begin removing recommended clinical review as an optional review for our commercial members, starting Jan. 1, 2027.

Watch for New Digital Interfaces To Simplify Prior Authorization Requests

Starting Jan. 1, 2027, we’ll offer application programming interfaces to simplify prior authorization requests and give you quicker access to your patients’ information.

Access Medicare Advantage Prior Authorization Decision Letters via Availity^® Essentials

Beginning Oct. 8, 2026, you’ll be able to view and securely download prior authorization decision letters for members with Medicare Advantage plans through the Provider Correspondence Viewer within Payer Spaces.

See Prior Authorization Changes for Some Commercial and Government Program Members

We’ve updated prior authorization requirements for some commercial members and government plans to reflect new, replaced or removed codes.

Encourage Routine Screening To Detect Breast Cancer Early

Breast cancer screening should begin at age 40 and continue every other year until age 74, according to the U.S. Preventive Services Task Force. See tips to close screening gaps.

Explore Learning Opportunities

We offer free training for providers who participate in our networks. View and sign up for sessions.

See Program Results for Blue Cross Medicare Advantage Dual Care Plus (HMO SNP)^SM

Every year, we measure how we’re meeting the goals for Blue Cross Medicare Advantage Dual Care Plus (HMO SNP), which serves older adults and people with disabilities. See the 2025 results.

Update and Verify Your Information in Provider Directory Pilot for Qualified Health Plans

Providers participating in marketplace plans can update and verify your information in one centralized statewide provider directory for Qualified Health Plans. Learn how to log in to verify every 90 days and update within 30 days of a change.

Remind Blue High Performance Network^® Members To See In‑Network Providers

You can help ensure members receive their full benefits and avoid unexpected out‑of‑pocket costs by recommending other in‑network BlueHPN^® providers. Learn how to identify these members.

Watch for New Edge Benefit Plan Members in 2027

Beginning Jan. 1, 2027, you may see members of our new Edge benefit plans, powered by Easify^SM. Edge plans are copay‑only PPO plans with tiered benefits based on which providers our members choose.

Looking for Help?

Do you know the fastest way to get a response on prior authorizations? Are you aware of the latest pharmacy drug updates, or do you have a claims question? You can find many answers on our provider website, including:

• The latest updates

• Details about tools to streamline billing and processes

• Tips for newly contracted providers

Contact Your Provider Relations Representative

If you have a question and can’t find an answer, our provider representatives are here to help. Email us or call 800‑722‑3730 and select Option 2 for network.

Learn About Updates to Reimbursement Policies

We regularly add and modify reimbursement policies, formerly known as clinical payment and coding policies, as part of our ongoing policy review. See which policies were updated.

Review Active and Pending Medical Policies

Approved new or revised medical policies and their effective dates are usually posted on our website the first and 15th of each month. You can view all active and pending policies, as well as draft medical policies, and provide comments on draft policies. These policies may impact your reimbursement and your patients’ benefits.