Name of Manual - Blue Cross and Blue Shield of Minnesota

Appeals
Supporting
Documentation
(continued)
Utilization Review
Decision Appeal
Type of Denial or
Reduction Documentation
Incompatible
Diagnosis
Letter requesting review of codes that are
denying as incompatible and related notes
Timely Filing Documentation supporting submission of
a claim after timely filing, such as
secondary coverage, patient expired
during timely filing period, or DME
rental charges that span the timely filing
period. Timely filing is addressed in
Chapter 8.
Coding Edit (Refer to
Chapter 11 for details)
All supporting documentation for
corresponding date of service.
Under current external review provisions, Provider or any other
authorized representative may initiate an external review appeal on
behalf of a Subscriber, with the express written authorization of
said Subscriber. Provider and Blue Cross agree that this appeal
process is binding, unless the Subscriber initiates an external
appeal related to Utilization Review decisions. In the event that a
Subscriber, a duly authorized representative of the Subscriber, or a
Provider initiates an appeal related to Utilization Review
decisions, Blue Cross shall abide by all applicable external review
requirements of Minnesota Statutes, Section 62Q.73.
10-8 Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (06/19/12)