Prosthetics, orthotics and footwear providers

Provider accounts

Resources

Contact Information

Alberta Blue Cross^®, Health Services, AADL

10009-108 Street Edmonton, AB T5J 3C5

Tutorial videos

• How to submit a claim
• How to submit an authorization
• How to access reports

General policy manual

• General policy and procedures

Policy and procedure manuals

• Orthotic and prosthetic benefits
• Custom-made footwear benefits
• Therapeutic footwear benefits
• Shoe elevation benefits
• Custom-made ocular prosthetic benefits

Approved product listings

• Orthotic benefits
• Prosthetic benefits
• Custom-made footwear benefits
• Therapeutic footwear benefits
• Shoe elevation benefits
• Custom-made ocular prosthetic benefits

Forms

Client Forms

• Client Consent Form
• Application for Cost-Share Exemption
• Application for Temporary Cost-Share Exemptions

General Forms

• Quantity Frequency Review (QFR) Request
• Quantity Frequency Review - Directors Appeal

Footwear Forms

• Custom Footwear Validation Certificate
• Therapeutic Footwear Prescription form
• Custom Made Footwear Benefits: New and Repeat Clients
• Custom Made Footwear Benefits: New Client Questionnaire
• Custom Made Footwear Criteria: All Clients
• Custom Made Footwear Eligibility Questionnaire: First Time Clients

Prosthetic and Orthotic Forms

• Prosthetic and Orthotic device validation certificate
• Prosthetic and Orthotic Benefits Approved Product List Addition
• Prosthetic Benefits Microprocessor Knee Client Declaration
• Prosthetic and Orthotic Calculator