Resources & Tools

Please use these reference materials to access the codes and guides you are looking for.

• Core Companion Guide
• 5010 835 - Electronic Remittance Advice Guide
• 5010 837I Institutional Guide
• 5010 837P Professional Guide
• 5010 Billing Guide
• 5010 EDI & Paper Billing Guidelines
• 5010 Overview
• 5010 Professional & Institutional Entry Error Codes
• Blue Cross Facility Notices
• Commonwealth Health Laboratory Services
• FPH Explanation Codes
• FPH Facility Notices
• FPH Professional Notices
• Members Rights
• PCP Profile & Incentive Reference Guide
• Plan & Alpha Prefix Guide
• Remittance Advice Field Definitions
• Wilkes-Barre General Radiology Sites

Governing Policy and Procedures

Beginning Jan. 1, 2016, providers will be governed by two sets of Policies and Procedures as they relate to treating patients:

• Patients who are still covered by First Priority Health (FPH) and First Priority Life Insurance Company (FPLIC) health plans because their coverage has not yet renewed for 2016
• Patients who are now covered by Highmark Blue Cross Blue Shield health plans because their coverage has renewed for 2016 and they have transitioned to a Highmark plan

Please Note: Effective Jan. 1, 2016:

• Patients that present a BCNEPA-branded ID card with a FPH/FPLIC alpha prefix are bound by the Policies and Procedures outlined in the BCNEPA Professional and Facility Policy and Procedure manuals.
• Patients that present a Highmark Blue Cross Blue Shield-branded ID card are governed by the Policies and Procedures outlined in the Highmark Blue Shield Office Manual and Highmark Facility Manual.

As always, it is essential that you review each patient’s member ID card and compare it to that member’s current Eligibility and Benefits (E&B) information on NaviNet to ensure the correct insurer’s policies/procedures apply.

To check E&B information for patients with a FPH/FPLIC alpha prefix, please utilize NEPA/FPH NaviNet, and for checking E&B information on patients with a Highmark BCBS alpha prefix, please utilize Highmark NaviNet.

Providers need to continue to check all future issues of the Provider Bulletin for updated alpha prefix information, including the complete alpha prefix chart once it is available

• BCNEPA Professional Policy/Procedure Manual
• BCNEPA Facility Policy/Procedure Manual

Select the provider form you wish to complete from the menu. These forms are to be used ONLY by physicians and/or facilities when requesting authorization for services.

• Affirmation of Medical Practice Statement
• Provider File Maintenance Request Fillable
• Request for Assignment Account Fillable
• Request for Addition/Deletion to Existing Fillable
• BCNEPA NaviNet Access
• BCNEPA's Discharge Notification Tool
• FPH/FPLIC Electronic Funds Transfer (EFT) Form
• CHIP - Physician Certification
• CHIP - Member Statement
• Medical Management Forms
• Adjustment Form Blue Cross/FPH
• Claims Reconsideration Form
• Claims Research/Appeals Form
• Notice of Provider's Agency Arrangement