Small Group Blues Enroll - Arkansas Blue Cross and Blue Shield

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ARKANSAS BLUE CROSS AND BLUE SHIELDSMALL GROUP BLUESENROLL GROUP ADMINISTRATOR’S MANUALSample Copies of forms:1. GROUP ENROLLMENT FORM2. CHANGE REQUEST FORM3. DENTAL APPLICATION AND CHANGE FORM4. APPLICATION FOR CONVERSION POLICY5. HEALTH CLAIM FORM6. DENTAL CLAIM FORM7. PRESCRIPTION CLAIM FORMSmall Group BluesEnroll R 10/25/07 35
ARKANSAS BLUE CROSS AND BLUE SHIELDSMALL GROUP BLUESENROLL GROUP ADMINISTRATOR’S MANUALSection 13 – HOSPITAL ADMISSION PRE-CERTIFICATION/PRE-NOTIFICATIONREQUIREMENTSSee the member’s Member card for the toll free number to call. If you have questionsabout any of the requirements listed on the following table, call the customer Service orProvider Service number on the membership card.Admission Pre-Certification RequirementsForArkansas Blue Cross and Blue Shieldand its AffiliatesPRODUCTLINEArkansas Blue Crossand Blue ShieldADMISSIONPRE-CERTIFICATIONNOExceptions: Federal EmployeeProgram (FEP) and out of networkOUTPATIENTPRE-CERTIFICATIONNOFederal EmployeeProgram (FEP)YESPlease note: All ID cards have theArkansas Blue Cross logo and ID #sbegin with “R.”NOAccess OnlyYESPlease note: Any ID card with theArkansas’ FirstSource logo (withoutthe Blue Cross and Blue Shieldsymbols) requires pre-certification.NOHealth AdvantageNO – All RegionsException: out of networkNO – All RegionsBlueAdvantageYESYESAdministrators of(Certain groups call 1-Arkansas800-USAble1 to verify.)If you have questions regarding pre-certification requirements for any of our products,please call Customer Service in your local regional office.Small Group BluesEnroll R 10/25/07 36
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Small Group Blues Enroll - Arkansas Blue Cross and Blue Shield

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