Manuals & Billing Instructions

Use our manuals as helpful resources in your day-to-day interactions with Blue Cross and Blue Shield of Florida. Bookmark our site and check back often for updates.

Note: Due to the large size of the manuals and billing guides, some documents may take several minutes to download.

The Manual for Physicians and Providers is a comprehensive reference manual designed to assist physicians, providers and their staff in understanding our networks, products, utilization management programs, and claims filing and reimbursement guidelines. The manual is organized into sections for your convenience. They are saved in the PDF format, which allows for a keyword(s) search within the section by pressing Ctrl+F and entering the keyword(s) in the box that appears. In addition, we have added bookmarks to allow users to search within each section by the respective topics outlined in the table of contents.

• Table of Contents (PDF)

Part I: Administrative Information

• Introduction and Contact Information, May 2009 (PDF)
• Electronic Self-Service Tools, June 2009 (PDF)
• Products and Plans, June 2009 (PDF)
• Pharmacy Programs, May 2009 (PDF)
• Participation Programs and Responsibilities, September 2009 (PDF)
• Utilization Management Programs, August 2009 (PDF)
• Coding and Filing Claims, July 2009 (PDF)
• Member Information, August 2009 (PDF)
• Overpayment Recovery and Audit, June 2009 (PDF)
• BlueSelect, July 2009 (PDF)
• Miami-Dade Blue, February 2009 (PDF)

Part II: Provider Specific Billing and Coding Guidelines

• Ancillary Facilities, September 2009 (PDF)
• Ancillary Providers, August 2009 (PDF)
• Inpatient Hospitals, June 2009 (PDF)
• Outpatient Hospitals and Ambulatory Surgical Centers, June 2009(PDF)
• Anesthesia Services, June 2009 (PDF)
• Chiropractic, November 2008 (PDF)
• Love Settlement Business Practices, December 2008 (PDF)
  
  
  
• Appendix (PDF)

Medicare Advantage BlueMedicare^SM PFFS

The BlueMedicare^SM PFFS Terms and Conditions of Payment (PDF) is designed to provide health care providers with information on the Private Fee-for-Service program, policies, billing procedures, and reimbursement guidelines. Or view PFFS Terms and Conditions of Payment for other Blues Plans.

BlueCard Program Manual

The BlueCard^® Program Manual (PDF) provides physicians and providers with BlueCard program administrative policies, billing procedures, and reimbursement guidelines.

Claim Form Billing Instructions

Instructions for completing the CMS-1500 and UB-04 claim forms can be obtained from the following websites:

• Centers for Medicare & Medicaid Services www.cms.gov
• Florida Hospital Association www.fha.org
• National Uniform Billing Committee www.nubc.org
• National Uniform Claim Committee www.nucc.org