Name of Manual - Blue Cross and Blue Shield of Minnesota

Appeals
Provider Appeals
Introduction Providers are eligible to appeal:
Post Service Claim
Appeals
Post service claim appeals
Prior Authorization and Preadmission Notification denials
Coding appeals
For information regarding settlement appeals, refer to your
provider agreement.
For information regarding submission of replacement or cancel
claims, refer to Chapter 8 in this manual.
Instructions for the submission of appeals are listed in this chapter.
Please read the information carefully to ensure your appeal is
reaching the appropriate area within Blue Cross and Blue Shield of
Minnesota (Blue Cross) as that will allow for an efficient and
timely review of your request.
A post service claim appeal is a written request for review.
The Minnesota Uniform Companion Guides, version 4.0, dated
March 2009, Section 4.2.3.2, define an appeal as “Provider is
requesting a reconsideration of a previously adjudicated claim but
there is no additional or corrected data to be submitted.”
Post service claim appeals require the provider to include with the
request documentation of items such as chart notes, medical
records, operative reports and letters of medical necessity. Appeals
present detailed information in an attempt to change a previous
decision made by Blue Cross.
All post service claim appeals must be submitted on the AUC
Appeal Request Form available on the AUC web site,
www.health.state.mn.us.auc, along with the supporting
documentation and must be mailed or faxed to the Consumer
Service Center.
A post service claim appeal must be requested within 90 days of
the date claim notification is issued. There is no limit on the dollar
amount for an initial appeal.
A standard claim appeal submitted with a completed AUC appeal
form and attached supporting documentation will be completed
within 60 days of receipt. The appeal decision is final unless the
charges in question exceed $500.00. At that time, a voluntary
second level review is available.
10-2 Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (06/19/12)