Name of Manual - Blue Cross and Blue Shield of Minnesota
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Name of Manual - Blue Cross and Blue Shield of Minnesota

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Health Care Options<br />

The following grid provides an overview <strong>of</strong> Platinum <strong>Blue</strong> services, CMS billing format, <strong>and</strong> Medicare Part A or Part B eligibility.<br />

Institutional = electronic format or paper (UB) form pr<strong>of</strong>essional = electronic format or paper (1500) form<br />

Billable to Medicare<br />

Inpatient <strong>and</strong> outpatient hospital including Acute<br />

Care Hospital, Indian Health Service Facility<br />

(IHS), Critical Access Hospital, Sole Community<br />

Hospital, Rehabilitation Hospital, etc.<br />

Medicare<br />

submission<br />

form/format Billable to <strong>Blue</strong> <strong>Cross</strong><br />

institutional<br />

Physician services rendered in the inpatient<br />

hospital setting <strong>and</strong> separately billed<br />

Hospital-based surgical center institutional Free-st<strong>and</strong>ing ambulatory surgical center (ASC)<br />

Inpatient <strong>and</strong> outpatient blood transfusions<br />

Outpatient hospital radiology <strong>and</strong> laboratory<br />

services<br />

Hospital based therapy including physical,<br />

occupational, <strong>and</strong> speech<br />

Individual private practice physical therapy <strong>of</strong>fice<br />

meeting CMS variance qualifications<br />

institutional<br />

<strong>and</strong>/or<br />

pr<strong>of</strong>essional<br />

institutional<br />

institutional<br />

Skilled Nursing Facility (SNF) institutional<br />

Hospice except for services not related to<br />

treatment <strong>of</strong> terminal condition<br />

ESRD facility (CMS approved dialysis facility) Bills<br />

for support services <strong>and</strong> back up dialysis <strong>and</strong><br />

emergency services only. (global fee<br />

includes some physician services)<br />

<strong>Blue</strong> <strong>Cross</strong><br />

submission<br />

form/format<br />

pr<strong>of</strong>essional<br />

institutional<br />

(deviates<br />

from CMS)<br />

Physician <strong>of</strong>fice visits pr<strong>of</strong>essional<br />

Pr<strong>of</strong>essional behavioral health services including<br />

Community Mental Health Centers<br />

Freest<strong>and</strong>ing clinic/physician group physical,<br />

occupational or speech therapy<br />

pr<strong>of</strong>essional<br />

pr<strong>of</strong>essional<br />

pr<strong>of</strong>essional Chiropractic services pr<strong>of</strong>essional<br />

institutional<br />

institutional<br />

<strong>and</strong>/or<br />

pr<strong>of</strong>essional<br />

Home health agencies institutional<br />

Federally Qualified Health Centers (FQHC) [both<br />

Independent <strong>and</strong> Provider based]<br />

Rural Health Clinic (RHC)<br />

[both Independent <strong>and</strong> Provider Based]<br />

institutional<br />

institutional<br />

SNF provision <strong>of</strong> certain prosthetics (PEN<br />

therapy) billed to DMERC<br />

Hospice services unrelated to treatment <strong>of</strong><br />

terminal condition <strong>and</strong> Medicare eligible<br />

Laboratory <strong>and</strong> X-rays including hospital<br />

reference labs<br />

Home health agencies (also approved as DME<br />

suppliers) billing for DMEPOS services<br />

Durable Medical Equipment (DME), prosthetics,<br />

orthotics, <strong>and</strong> medical supplies<br />

pr<strong>of</strong>essional<br />

pr<strong>of</strong>essional<br />

pr<strong>of</strong>essional<br />

pr<strong>of</strong>essional<br />

pr<strong>of</strong>essional<br />

Hospital-based ambulance institutional Ambulance pr<strong>of</strong>essional<br />

<strong>Blue</strong> <strong>Cross</strong> <strong>and</strong> <strong>Blue</strong> <strong>Shield</strong> <strong>of</strong> <strong>Minnesota</strong> Provider Policy <strong>and</strong> Procedure <strong>Manual</strong> (12/27/10) 5-17

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