Name of Manual - Blue Cross and Blue Shield of Minnesota

Mental Health and
Chemical Dependency
Services
Blue Plus
Blue Plus members may coordinate their evaluation/management
(E/M) or medication management services through their PCC or
their designated behavioral health provider. E/M and medication
management services performed outside of their PCC or
designated behavioral health provider will require a referral from
the member’s PCC in order to receive the highest level of benefits.
Most groups do not require referrals for claims to process at the
highest level. However, member contracts that require the member
to stay in the Select behavioral health network would need
authorization from Blue Plus to see a provider outside of that
network. PCCs do not need to initiate referrals for patients
requiring mental health/chemical dependency care.
OB/GYN Services State legislation requires open access for specified ob/gyn services
under managed care contracts. When a member obtains eligible
ob/gyn services, she may go to her PCC or elect to seek care from
any ob/gyn network provider without a referral from the PCC and
receive the highest level of her benefits. This benefit is effective
for fully-insured groups. This benefit is optional for self-insured
groups.
OB/GYN Open Access
Additional Services
• Eligible services: The member can go to any ob/gyn network
provider for approved services. The approved services are
considered services billed by a network ob/gyn with a
diagnosis code on our approved list. (See the list later in this
chapter.)
If a member’s needs expand beyond the specified ob/gyn openaccess
benefits, the member needs to be directed back to her
designated PCC or be referred by her PCC in order for the care to
be coordinated by the member’s PCC.
For example, when the ob/gyn provider identifies ovarian cancer
and the member needs to see an oncologist, the member should be
directed back to her PCC, because the oncologist is not an ob/gyn
provider. The open access benefit is only for services billed by
ob/gyn providers.
For those members who have an open access benefit, eligible
inpatient and outpatient hospital and related ob/gyn services are
covered at the member’s highest benefit level. An open access
ob/gyn provider must coordinate the services. We may not be able
to identify these claims during initial processing. Adjustments to
claims may be requested electronically through provider web selfservice,
or by calling Provider Service.
Blue Cross Blue Shield of Minnesota Provider Policy and Procedure Manual (12/27/10) 6-23