Name of Manual - Blue Cross and Blue Shield of Minnesota

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MII Life, Incorporated Health Care Options History MII Life, Incorporated administers reimbursement account products (flexible spending accounts, health reimbursement arrangements, health savings accounts) under the name SelectAccount ® . MII Life, Inc., d.b.a. SelectAccount, is an independent company providing account administration services. Products and Services SelectAccount’s product line includes: • Flexible spending accounts (FSAs) • Medical savings accounts (MSAs) • Health reimbursement arrangements (HRAs) • Health savings accounts (HSAs) • VEBA accounts • Transportation reimbursement accounts These products are offered as stand-alone products or in conjunction with Blue Cross plans. • SelectAccount customer service ............1-800-859-2144 Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (12/27/10) 5-27
Health Care Options Prime Therapeutics LLC History Prime Therapeutics, LLC is Blue Cross’ pharmacy benefits manager (PBM). Prime Therapeutics, LLC is an independent company providing pharmacy benefit management services. Formularies Blue Cross offers two formulary options to meet customer and member needs. GenRx is the formulary option designed for maximum value in pharmacy spending for clients and members while maintaining the highest standards in therapeutic safety and effectiveness. Its focus is to provide the same high therapeutic standard as FlexRx by having both brand-name and specialty drugs on this formulary while placing greater emphasis on lower-cost generic equivalents. GenRx addresses a rapidly growing need in a marketplace looking for high-quality, cost-conscious benefit solutions. FlexRx is the broadest formulary option providing the highest standard of therapeutic safety and effectiveness through a combination of brand-name and generic drugs, including specialty drugs. 5-28 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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Integrated Health Management Medica
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Page 91 and 92: Integrated Health Management Decisi
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Page 95 and 96: Integrated Health Management For Lo
Page 97 and 98: Integrated Health Management Appeal
Page 99 and 100: Integrated Health Management Case &
Page 101 and 102: Integrated Health Management Diseas
Page 103 and 104: Integrated Health Management Focuse
Page 105 and 106: Integrated Health Management Specia
Page 107 and 108: Integrated Health Management Overvi
Page 109 and 110: Integrated Health Management Medica
Page 111 and 112: Integrated Health Management Sample
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
Page 131 and 132: Health Care Options Minnesota Senio
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Page 135 and 136: Health Care Options BlueLinkTPA Blu
Page 137: Health Care Options Delta Dental Hi
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]
Page 167 and 168: Blue Plus Special Member Benefits O
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 ®
Page 177 and 178: BlueCard® Identifying BlueCard ®
Page 179 and 180: BlueCard® BlueCard Service Claims
Page 181 and 182: BlueCard® Prior Authorization and
Page 183 and 184: BlueCard® Electronic Data Intercha
Page 185 and 186: BlueCard® Claims Processed by the
Page 187 and 188: 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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Blue Cross and Blue Shield of Minne
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Coding Policies and Guidelines (Mat
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Coding Policies and Guidelines (Med
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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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Coding Policies and Guidelines (Sur
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