Name of Manual - Blue Cross and Blue Shield of Minnesota

Care Management
Numbers and
Addresses (continued)
Area
Medical Dental
Prior Authorization Requests
(may be faxed or mailed)
Surgical TMJ services
Orthognathic/osteotomies
Orthodontics for TMJ and
cleft lip/palate
Bone grafts
Bridges for accidental injuries
Anesthesia and
inpatient/outpatient hospital
charges for dental care
provided to a covered person
who is a child under age five
(5); is severely disabled or has
a medical condition that
requires hospitalization or
general anesthesia for dental
treatment.
PT/OT/ST
Prior Authorization Requests
(may be faxed or mailed)
Participating providers
(Refer to Chapter 4-Care
Management for details)
Transplants
Prior Authorization Requests
(may be mailed or phoned)
Phone/Fax Numbers
and Addresses
FAX: (651) 662-7816
At Your Service
Address:
Blue Cross and Blue Shield of
Minnesota
Medical-Dental Review
R4-72
P.O. Box 64265
St. Paul, MN 55164-0265
FAX: (651) 662-7816
Address:
Blue Cross and Blue Shield of
Minnesota
Allied Health Services
R4-72
P.O. Box 64265
St. Paul, MN 55164-0265
(651) 662-9936 or
1-866-309-6564
FAX: 651-662-1624
Address:
Blue Cross and Blue Shield of
Minnesota
P.O. Box 64179
Route R4-72
St. Paul, MN 55164-0265
Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (10/24/11) 1-11