Name of Manual - Blue Cross and Blue Shield of Minnesota

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Claims Filing Employment.........................................................................................................................8-43 Incident To...........................................................................................................................8-43 Direct Supervision ............................................................................................................... 8-44 General Supervision.............................................................................................................8-44 Collaboration/ Independent Practice....................................................................................8-44 Chiropractic Doctors and Multidisciplinary Clinics............................................................8-44 Surgical Technicians............................................................................................................8-45 Mid-level Practitioners.........................................................................................................8-45 Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (05/10/12) 8-3
Claims Filing Administrative Simplification Introduction Minnesota Statute 62J.536, requires health care providers and group purchasers (payers, health plans) to exchange eligibility requests, claims and remittances electronically using standard formats. The intent of the law is to reduce costs, simplify and speed up health care transactions, and to give providers and health plans one set of rules to follow for electronic transactions. This statute applies to all health care providers in Minnesota, regardless of participating status. Web-based Claim Submission, Eligibility, and Remittance Tool Pharmacy and Dental Claims Blue Cross and Blue Shield of Minnesota (Blue Cross) offers a nocost, web-based tool through Availity to comply with the Minnesota Statute 62J.536. Availity, an independent company, also provides no-cost solutions to obtain eligibility and benefits as well as viewing your remittance information. Availity, an independent company, is a one stop shop that optimizes information exchange between multiple heath care stakeholders through a single secure network. Providers may also take advantage of a range of optional, value-added services for a nominal cost. For more information contact Availity at availity.com to register for their no-cost web-based tools. The requirement to submit all claims electronically includes dental and pharmacy formatted claim types. Blue Cross is completing system changes to accept and properly adjudicate these electronic claim types. Due to the complexity of the changes and need for extensive testing, Blue Cross can not accept dental formatted or pharmacy formatted electronic claims at this time. Pharmacy and dental providers should continue to submit these claim types on paper until notified by Blue Cross. 8-4 Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (05/10/12)
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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 Overvi
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Integrated Health Management Pre-Ce
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Integrated Health Management Decisi
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Integrated Health Management Defini
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Integrated Health Management For Lo
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Integrated Health Management Appeal
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Integrated Health Management Case &
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Integrated Health Management Diseas
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Integrated Health Management Focuse
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Integrated Health Management Specia
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Integrated Health Management Overvi
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Integrated Health Management Sample
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Health Care Options Prepaid Medical
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Health Care Options Member ID Cards
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Health Care Options Blue Cross and
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Health Care Options Double Gold Dou
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Health Care Options Medicare Basic
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Health Care Options Platinum Blue S
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Health Care Options MedicareBlue PP
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Health Care Options Inquiries and C
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Health Care Options Additional info
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Health Care Options Minnesota Senio
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Health Care Options MinnesotaCare P
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Health Care Options BlueLinkTPA Blu
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Health Care Options Delta Dental Hi
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Health Care Options Prime Therapeut
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Health Care Options Workers' Compen
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Health Care Options HICF 1500 Form
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Health Care Options Networks Blue C
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Blue Plus Member Information Introd
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Blue Plus Member Rights and Respons
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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
Page 185 and 186: BlueCard® Claims Processed by the
Page 187 and 188: BlueCard® Overview (continued) 3.
Page 189 and 190: BlueCard® Claim Payment Guidelines
Page 191 and 192: BlueCard® Calls from Members and O
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Page 195 and 196: BlueCard® Types of Medicare Advant
Page 197 and 198: BlueCard® Medicare Advantage Claim
Page 199 and 200: BlueCard® Reimbursement for Medica
Page 201: Claims Filing HCPCS/ Accommodation
Page 205 and 206: Claims Filing Claims with Attachmen
Page 207 and 208: Claims Filing Claims with Coordinat
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Page 211 and 212: Claims Filing 1500 HICF Form Profes
Page 213 and 214: Claims Filing Ordering Forms and Ma
Page 215 and 216: Claims Filing Site of Service (cont
Page 217 and 218: Claims Filing Institution (837I) /F
Page 219 and 220: Claims Filing Treatment Room Blue C
Page 221 and 222: Claims Filing Single facility claim
Page 223 and 224: Claims Filing Present on Admission
Page 225 and 226: Claims Filing Medicare Crossover Bl
Page 227 and 228: Claims Filing Cancel/Void and Repla
Page 233 and 234: Claims Filing Verifying Patient Eli
Page 235 and 236: Claims Filing Basic Character Set V
Page 237 and 238: Claims Filing Rural Health Clinics
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Page 241 and 242: Claims Filing TEFRA The 1982 Tax Eq
Page 243 and 244: Claims Filing Employment As defined
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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 (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 (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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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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