Policies, Manuals and Guides

We are committed to supporting you in providing quality care and services to Healthy Blue members. Here you will find information for assessing coverage options, guidelines for clinical utilization management (UM), practice policies and support for delivering benefits to our members.

Provider Manual

Healthy Blue’s provider manual provides key administrative information including the quality improvement program, the UM program, quality standards for participation, claims appeals, and reimbursement and administration policies.

View or download the provider manual.

View or download the Quick Reference Guide.

Pharmacy Criteria

For pharmacy prior authorization criteria, please see documents posted at the following link: https://medicaid.ncdhhs.gov/providers/clinical-coverage-policies/pharmacy-services-clinical-coverage-policies

Interested in becoming a provider in the Healthy Blue network?

We look forward to working with you to provide quality services to our members.