Name of Manual - Blue Cross and Blue Shield of Minnesota

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Healthy Start ® Prenatal Support Healthy Start ® Prenatal Support Healthy Start ® Prenatal Support (continued) Health Care Options Healthy Start is a personalized program designed to assess, educate and support pregnant women and their health care providers to achieve optimal childbirth outcomes. Registered nurses who are experienced in obstetrics work with the expectant mother to help her achieve a normal full-term delivery. With a quick phone call, a Healthy Start nurse is there to give answers and support. Healthy Start offers these features: • An experienced obstetrics registered nurse who educates the mother-to-be on having a healthy pregnancy and answers her questions. • Comprehensive educational material that is tailored to the specific needs of the mother-to-be. • Guidance on nutrition, exercise, birth planning, stress management, relieving discomfort, explanation of procedures and much more. • A reward card to the participant’s choice of major retail stores. There is no cost for participation in the Healthy Start program. Healthy Start is available to all Blue Cross fully insured members, Blue Plus members and members of self-insured groups that have purchased this program. It is not available to members with individual policies. To enroll, please instruct members who are expecting a baby to the back of their member ID card for the appropriate contact number. Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (12/27/10) 5-25
Health Care Options Delta Dental History Delta Dental of Minnesota offers dental coverage to individuals and small and large groups in Minnesota. Delta Dental operates pursuant to an administrative service agreement with Blue Cross. Delta Dental of Minnesota is independent from Blue Cross. Delta Dental provides administrative services for dental benefits. Inquiries Delta Dental inquiries may be directed to: Delta Dental 3560 Delta Dental Drive Eagan, MN 55112 Phone: (651) 406-5900 or 1-800-328-1188 Fax: (651) 994-5035 Website: www.deltadentalmn.org 5-26 Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (12/27/10)
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Blue Cross and Blue Shield of Minne
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Recent Chapter changes: Chapter 11
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Chapter 11 - Coding Policies and Gu
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Durable Medical Equipment Date Topi
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Medical Emergency Date Topic Change
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Rehabilitative Services Date Topic
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Table of Contents Chapter 1 At Your
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Introduction Provider Policy and Pr
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How to Contact Us At Your Service P
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At Your Service Claims Address Subm
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Care Management Numbers and Address
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Care Management Numbers and Address
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Company Phone Number Address Public
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At Your Service Provider Identifica
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ID Cards At Your Service Introducti
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Electronic Commerce Overview An imp
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Remote Access Services (continued)
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Provider Communications Provider Co
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Health Plan Members have the Follow
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Provider Agreements Participation a
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Provider Agreements Responsibilitie
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Provider Agreements Provider Number
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Provider Agreements Accounting for
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Provider Agreements Carrier Replace
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Table of Contents Chapter 3 Quality
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Quality Improvement Leadership Rati
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Quality Improvement Telephone Care:
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Quality Improvement Quality of Care
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Quality Improvement Written Policie
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Quality Improvement Written Policie
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Quality Improvement Patient Safety
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Quality Improvement Medical Record
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Quality Improvement Institute for C
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Quality Improvement Quality Improve
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Quality Improvement Physical Facili
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Quality Improvement Treatment Recor
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Integrated Health Management Progra
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Integrated Health Management Provid
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Integrated Health Management Utiliz
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Integrated Health Management Medica
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Page 113 and 114: Health Care Options Prepaid Medical
Page 115 and 116: Health Care Options Member ID Cards
Page 117 and 118: Health Care Options Blue Cross and
Page 119 and 120: Health Care Options Double Gold Dou
Page 121 and 122: Health Care Options Medicare Basic
Page 123 and 124: Health Care Options Platinum Blue S
Page 125 and 126: Health Care Options MedicareBlue PP
Page 127 and 128: Health Care Options Inquiries and C
Page 129 and 130: Health Care Options Additional info
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Page 141 and 142: Health Care Options Workers' Compen
Page 143 and 144: Health Care Options HICF 1500 Form
Page 145 and 146: Health Care Options Networks Blue C
Page 147 and 148: Blue Plus Member Information Introd
Page 149 and 150: Blue Plus Member Rights and Respons
Page 151 and 152: Blue Plus Member Rights and Respons
Page 153 and 154: Blue Plus Member Benefits Members
Page 155 and 156: Blue Plus Quality of Care Complaint
Page 157 and 158: Blue Plus Referral Points Remember
Page 159 and 160: Blue Plus Referral Not Required We
Page 161 and 162: Blue Plus Standing Referral Minneso
Page 163 and 164: Blue Plus Clarifications of Terms (
Page 165 and 166: Blue Plus [Date] [Name of patient]
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Page 169 and 170: Blue Plus OB/GYN Open Access Diagno
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Page 173 and 174: BlueCard® Claim Status Inquiry ...
Page 175 and 176: BlueCard® Identifying BlueCard ®
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Page 179 and 180: BlueCard® BlueCard Service Claims
Page 181 and 182: BlueCard® Prior Authorization and
Page 183 and 184: BlueCard® Electronic Data Intercha
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BlueCard® Overview (continued) 3.
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BlueCard® Claim Payment Guidelines
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BlueCard® Calls from Members and O
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BlueCard® Guidelines (continued) W
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BlueCard® Types of Medicare Advant
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BlueCard® Medicare Advantage Claim
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BlueCard® Reimbursement for Medica
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Claims Filing HCPCS/ Accommodation
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Claims Filing Administrative Simpli
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Claims Filing Claims with Attachmen
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Claims Filing Claims with Coordinat
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Claims Filing Claims with Coordinat
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Claims Filing 1500 HICF Form Profes
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Claims Filing Ordering Forms and Ma
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Claims Filing Site of Service (cont
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Claims Filing Institution (837I) /F
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Claims Filing Treatment Room Blue C
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Claims Filing Single facility claim
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Claims Filing Present on Admission
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Claims Filing Medicare Crossover Bl
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Claims Filing Cancel/Void and Repla
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Claims Filing Verifying Patient Eli
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Claims Filing Basic Character Set V
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Claims Filing Rural Health Clinics
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Claims Filing Coordination of Benef
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Claims Filing TEFRA The 1982 Tax Eq
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Claims Filing Employment As defined
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Claims Filing Surgical Technicians
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Reimbursement / Reconciliation Reim
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Reimbursement / Reconciliation Comp
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Reimbursement / Reconciliation Remi
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Reimbursement / Reconciliation Ques
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Reimbursement / Reconciliation Ques
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Reimbursement / Reconciliation Acco
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Reimbursement / Reconciliation Fiel
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Appeals Provider Appeals Introducti
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Appeals Submitting Requests for Pos
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Appeals Coding Appeals (continued)
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Appeals Supporting Documentation (c
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Coding Policies and Guidelines (Cod
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Coding Policies and Guidelines (Cop
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Coding Policies and Guidelines (Mod
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Chapter 11 Coding Policies and Guid
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Part-time (Medically Directed) Anes
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Electroconvulsive Treatments Blue C
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Moderate (Conscious) Sedation Monit
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Coding Policies and Guidelines (Beh
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Coding Restrictions Code Restrictio
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CTSS Skills Training and Developmen
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Intensive Residential Treatment Ser
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IRTS Member Eligibility IRTS Access
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Adult Non-Residential Crisis Servic
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MH-TCM Services to Minnesota Health
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Dialectical Behavioral Therapy/DBT
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Autism Spectrum Disorder/EIBI (cont
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Autism Spectrum Disorder/EIBI (cont
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Psychiatric Consultation to Primary
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Psychiatry and Chemical Dependency
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Medication Management M0064 and 908
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Nutritional Counseling/Medical Nutr
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Practitioner Key MD = Psychiatrist
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Clinical Supervision Under Minnesot
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DIAMOND Initiative (continued) Reim
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Missed Appointments (continued) Cou
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Guidelines for Court Ordered Evalua
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Guidelines for Court Ordered Evalua
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Behavioral Health Quality Improveme
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Pre-certification and Concurrent Re
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Coding Policies and Guidelines (Chi
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Coding Policies and Guidelines (Den
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Coding Policies and Guidelines (Den
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Prior Authorization Requirements Co
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Coding Policies and Guidelines (Dur
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Waivers and Upgraded/Deluxe DME Wai
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Hearing Aids (continued) Website Co
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Portable Oxygen Billing (continued)
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DME/Supply Internet Purchases Codin
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Coding Policies and Guidelines (Hom
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Elderly Waiver Program (continued)
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Referrals and Prior Authorization (
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Referrals and Prior Authorization (
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Adult Day Care Bath Services Coding
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Home Infusion (continued) Coding Po
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Coding Policies and Guidelines (Hom
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Rules and Regulations (continued) H
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Hospice Billing for Medicare Produc
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Coding Policies and Guidelines (Hos
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Coding Policies and Guidelines (Lab
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Papanicolaou Smears (continued) Dia
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Coding Policies and Guidelines (Mat
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Coding Policies and Guidelines (Opt
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Coding Policies and Guidelines (Pha
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Drugs Coding Policies and Guideline
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Drug Programs Coding Policies and G
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Coding Policies and Guidelines (Pub
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Coding Policies and Guidelines (Rad
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Physical Therapy Evaluation Codes C
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Hot and Cold Pack Exclusion TMJ Ort
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Massage and Manual Therapy Exclusio
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MHCP PT, OT, ST Authorization Proce
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Bilateral Services (continued) Codi
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Coding Policies and Guidelines (Sur
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Acne Treatment/ Skin Rejuvenation a
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Liposuction Edit Change Coding Poli
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Assistant Surgeons (continued) Assi
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