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28 11/2005
Non-Compliance Policy
The purpose of the Non-Compliance Policy is to monitor and assure compliance with
BCBSGa/BCBSHP administrative and UM policies and operational requirements
pursuant to participation agreements with hospitals.
BCBSGa/BCBSHP will notify hospitals of any documented occurrence of administrative
non-compliance with their contract. BCBSGa/BCBSHP will track occurrences and
provide notification and necessary education to the hospital and staff.
Examples of administrative non-compliance include, but are not limited to:
• Balance billing members when member has no financial liability
• Failure to use/call in a network physician to admit a BCBSGa/BCBSHP member to
the emergency room
• Referral of a member to an out-of-network provider
• Failure to obtain required pre authorization for admissions and/or procedures
• Failure to provide timely information for prospective reviews
• Failure to call in a network physician for a specialist consultation
Please contact your regional network services department with questions regarding
the non-compliance policy applicable to your facility.