Name of Manual - Blue Cross and Blue Shield of Minnesota

Referral Required If the PCC authorizes the care outside the PCC, referrals are
required to be communicated to Blue Plus for:
Blue Plus
• Home health care/home IV
• Outpatient surgery
• Psychological testing submitted with a medical diagnosis
• Visits to a specialty provider
• Inpatient skilled nursing facilities (SNF) - a referral is required
along with a prior authorization
• Minnesota Health Care Programs and SecureBlue members do
not require a referral for the SNF charges; but, the provider is
required to send in a Nursing Home Communication Form
• Inpatient admissions – including hospitals
• Inpatient hospital admissions – a referral will be assumed when
the preadmission notification is completed, if the admitting
physician is from the member’s PCC
There are times when a referral is appropriate for behavioral health
services. If this is the case, you can call 1-800-262-0820 or local
(651) 662-5200 to discuss referral needs. This phone number can
also be used to see which providers are in the behavioral health
network. Minnesota Health Care Program Members have direct
access to network providers. In rare instances, out-of-network
exceptions may be considered. Call the above numbers for further
information.
There also may be exceptions in situations where the patient has
open-access benefits for a particular type of service.
Blue Cross Blue Shield of Minnesota Provider Policy and Procedure Manual (12/27/10) 6-13