Virtual Health
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Health Information Network (HIN)
Provides access to patient information including demographics, eligibility and benefits, claims, claim submission, claim correction, claim status, remittance advices, fee schedules, and more.
Learn more about HINInterQual® 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.
Please consult your provider for applicable policies and/or criteria.
Coverage policy
Quickly search for coverage information using a keyword, procedure code, policy number or title.
View coverageValue-based programs
Learn more about our value-based care program, which rewards providers for coordinating care and for positive health outcomes.
View value-based careBlue Distinction Centers
The Blue Distinction program highlights medical facilities demonstrating expertise in delivering quality healthcare.
View Blue Distinction CentersTotal Care
Total Care recognizes doctors that focus on health care instead of sick care. Total Care is coordinated, patient-focused and, in many cases, more affordable healthcare.
Learn more about Total CareNetwork participation guidelines
Access network participation guidelines and policies for credentialing standards.
View guidelinesNetwork development reps (NDRs)
Contact one of our medical network representatives with questions or billing issues.
Contact NDRsMy BlueLine
Participating providers may call My BlueLine for eligibility, claim status and benefit information for patients.
Contact My BlueLine