Name of Manual - Blue Cross and Blue Shield of Minnesota

Referrals to Case and Disease Management
Case Management Maximize optimal health and functional outcomes
Referrals to
Commercial Case
Management
Referrals to
Government Programs
Case Management
Identify gaps in care
Integrated Health Management
Reach out to the members with the greatest need and educate
them about their condition
Support and encourage individual accountability for health and
wellness (self-care management)
Help members coordinate their needs and navigate services in
the health care system
Tailor interventions and outreach to promote the appropriate
use of health care services
Improve member satisfaction with the health plan and health
care system
A referral can be made by contacting the case management support
staff at (651) 662-5520 and toll free at 1-888-878-0139 extension
25520.
A referral to case management can be made by calling
(651) 662-5540, or toll free at 1-800-711-9868.
Please contact Government Programs Case Management when you
have a patient who may need additional supportive services, such
as a Restricted Recipient referral.
Disease Management Disease management is a multidisciplinary, continuum-based
approach to health care delivery that proactively identifies
populations who have or are at risk for, chronic medical and
behavioral health conditions. Disease management supports the
practitioner-patient relationship and plan of care, emphasizes the
prevention of exacerbation and complications using cost-effective,
evidence-based practice guidelines and patient empowerment
strategies such as education and self-management. The process of
disease management evaluates clinical, social/humanistic and
economic outcomes with the goal of improving overall health of
the whole person.
Members who receive disease management services receive
support from a dedicated clinician, who assists in facilitating the
health of the whole person, not just their individual condition.
*Services are offered to members, participation is optional.
* Member eligibility for disease management is determined by the
member/subscriber contract.
Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (06/19/12) 4-25