Name of Manual - Blue Cross and Blue Shield of Minnesota

Blue Plus
Standing Referral Minnesota law provides for a standing referral. Standing referrals
are for longer-term, ongoing care by a specialty provider. They
may be established at any time at the PCCs discretion. Referrals
must be communicated to Blue Plus prior to services being
rendered. PCCs determine the number of referral visits and the
length, up to 365 days.
Mandatory standing referrals to a specialist qualified to treat the
specific condition must be granted, upon request, to a member with
any one of the following conditions.
• A chronic health condition
• A life threatening mental or physical condition
• Pregnancy beyond the first trimester if the member’s plan does
not offer open access benefits to
• Ob/gyn network providers
• A degenerative disease or disability
• Any other condition or disease of sufficient seriousness and
complexity to require treatment by a specialist
Routine standing referrals are still at the discretion of the PCC.
PCCs are not required to authorize a referral to accommodate
personal preference, convenience, or other non-medical reason.
While mandatory-standing referrals must be provided, the PCC
can determine the total number of visits within the 12-month
period based on the member’s medical condition. If the PCC has
the specialist within its clinic/care system, the PCC may request
that the member receive services there. PCCs must communicate
referrals to Blue Plus prior to referred services being rendered.
This law permits specialists, in agreement with the member and
PCC, to provide primary care services, authorize tests and services,
and even make secondary referrals. If the PCC does not grant the
member’s standing referral request, the PCC should inform the
member that he or she can file a complaint with Blue Plus by
calling the telephone number on the back of the member ID card.
6-16 Blue Cross Blue Shield of Minnesota Provider Policy and Procedure Manual (12/27/10)