Name of Manual - Blue Cross and Blue Shield of Minnesota

Integrated Health Management
Medical Referrals To
Nonparticipating
Providers
Blue Cross participating providers are required to direct their feefor-service
patients to other participating providers, including
anesthesiologists, radiologists, pathologists and surgical assistants.
Directories of participating providers are available upon request by
contacting provider services. Many times the member will have
reduced benefits and higher patient responsibility when using
nonparticipating providers.
Directing patients to nonparticipating providers may be necessary
in the following situations:
medical emergency
participating providers are not available within certain
geographic areas
quality of care or specialty care requires use of a
nonparticipating provider
Note: This is for Blue Cross fee-for-service contracts. Use the
Referral Network directory available on our website for
Blue Plus managed care referrals. Typically, the member
will receive the highest level of their benefits when
receiving a referral for those services that require a referral.
For complete information on Government Programs
requirements, please refer to Chapter 3 in the Blue Plus
Provider Manual.
If it is necessary to refer to a nonparticipating provider, the
participating physician must give the patient advance,
written notification that the referral is to a nonparticipating
physician. Once notice is given, the patient is responsible for
any increased liability if he or she decides to schedule the
service. If the patient is not properly informed, the provider
making the referral to a nonparticipating provider will be
liable for increased costs incurred by a patient.
Sample Waivers A sample waiver for use in your office is available on our website.
The waivers include the information required in order for you to
hold the member financially liable for services. The waiver should
be incorporated into your usual business forms and should be
customized to include your business letterhead.
4-34 Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (06/19/12)