Name of Manual - Blue Cross and Blue Shield of Minnesota

Integrated Health Management
Disease States Commercial Government Programs
Access Management
Programs
Asthma
Coronary Artery Diseases (CAD)
Chronic Kidney Disease (CKD)
Chronic Obstructive Pulmonary Disease (COPD)
Depression
Diabetes
Heart Failure
Low Back Pain
Oncology
In addition to the above conditions, Blue Cross also offers a
prenatal support program (Healthy Start ® Prenatal Support) to
eligible members. Please contact customer service to determine if a
member is eligible.
A dedicated nurse or clinician may contact your office for
assistance with a Blue Cross member’s needs. They may also send
you a letter including member goals and/or gaps in care to inform
you on what we are working with the member to advance their
health care needs. We look forward to working with our member’s
practitioners to make a healthy difference in our member’s health.
Access management is a specialized program for fully insured
commercial and Minnesota Health Care Program members.
Blue Plus members include members with coverage through:
Prepaid Medical Assistance Program Services for Persons
Under Age 65 (PMAP and MinnesotaCare Program Services
(MNCare). MHCP also refers to this program as the Restricted
Recipient Program.
Restrictions of Medicare services are not allowable per DHS
contract 2.119. For members who are on Medicare integrated
product (SecureBlue SM [HMO SNP]), it is permissible to restrict
Medicaid-only services. Blue Plus is not able to restrict Part D
drug coverage and implement physician sole prescribers for public
program members with Medicare (MSC+). If a MSC+ member is
not Medicare eligible, restriction is permissible.
4-26 Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (06/19/12)