Blue Advantage Coverage Determinations and Policies
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National Coverage Determinations
Refer to the following to search for National Coverage Determinations:
Local Coverage Determinations
Refer to the following Local Coverage Determination sites:
- Palmetto GBA
- CIGNA Government Services DME MAC Jurisdiction C Local Coverage Determinations
- Palmetto GBA RHHI Local Coverage Determinations
Blue Advantage Medical Policies
Our Blue Advantage draft and final medical policies are displayed on this site. Medical policies are based on the most current medical research available at the time of the policy development.
Policies are written to cover a given condition for the majority of people. Each individual's unique clinical circumstances may be considered in light of current scientific literature. Medical policies are based on constantly changing medical science and the Plan reserves the right to review and update our policies as necessary.
We encourage practicing physicians to provide input related to developing, adopting and reviewing criteria for medical policy. Any licensed practitioner is welcome to provide comments, suggestions or concerns. Our internal policy committee will review and take your comments into consideration. For medical policy feedback, email comments to email@example.com.
Reasonable and Necessary
In the absence of a Local Coverage Determination, National Coverage Determination, Blue Advantage medical policy, or the Centers for Medicare & Medicaid Services Manual Instruction, reasonable and necessary guidelines still apply. Refer to Medicare Program Integrity Manual Publication 100-08, Chapter 3, Section 220.127.116.11.
There are several exceptions to the requirement that a service be reasonable and necessary for diagnosis or treatment of illness or injury in order to be considered for payment. The exceptions appear in the full text of Title XVIII Section 1862(a)1(A) of the Social Security Act.
Notice of Nondiscrimination - Blue Advantage
Blue Cross and Blue Shield of Alabama complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. We do not exclude people or treat them differently because of race, color, national origin, age, disability or sex.