Name of Manual - Blue Cross and Blue Shield of Minnesota

More documents

Recommendations

Info

Preventive Care Services (continued) Service Frequency (does not apply to Blue Plus) Radiology: Osteoporosis Screening Laboratory Services: Cholesterol/Lipid Profile, Urinalysis Blue Cross Blue and Shield of Minnesota Provider Policy and Procedure Manual (07/12/12) Coding Policies and Guidelines (Coding) 1 per year ICSI As recommended by physician Diabetes Screening As recommended by physician STD Screening: HIV, Chlamydia, Gonorrhea, Syphilis Preventive Medical Examination for Adults including Skin Exam, Testicular Exam, Prostate- Digital Rectal Exam, Breast Exam, Hypertension Screening As recommended by physician As recommended by physician Cancer screening paid at the highest level Clinical Practice/ Guidelines ICSI Blue Cross ICSI/Mandate Blue Cross and ICSI Service Frequency Clinical Practice/ Guidelines Colon Cancer Screening: Occult Blood Colon Cancer Screening: Barium Enema, Sigmoidoscopy, Proctosigmoidoscopy Colon Cancer Screening: Colonoscopy Cervical Cancer Screening: Pap Smear Breast Cancer Screening: Conventional Film Screen Mammography 1 per year ICSI/ACS As recommended by physician As recommended by physician ICSI/ACS ICSI/ACS 1 per year ICSI.ACS 1 per year ICSI.ACS 11-11
Coding Policies and Guidelines (Coding) Preventive Care Services (continued) 11-12 Service Frequency (does not apply to Blue Plus) Prostate Cancer: Prostate Specific Antigen (PSA) Ovarian Cancer: CA125, For those at high risk and Trans-vaginal Ultrasound Clinical Practice/ Guidelines 1 per year Blue Cross/ Mandate 1 per year Blue Cross/ Mandate Services for consideration under the illness/medical level of benefit Any/all services that have an increased frequency due to an effort to control or prevent abnormal condition from recurring Procedures not considered preventive according to evidencebased guidelines developed as clinical and industry standards; for example, chest X-rays, urinalysis, complex lab and diagnostic imaging procedures Contraceptive management that is not part of Patient Protection and Affordable Care Act (PPACA) women’s preventive “contraceptive methods and counseling” Eyewear including lenses, frames and contract lenses Using the current version of the ICD-9-CM, report the patient’s condition at the highest level of certainty that are related to the services provided. Both the findings (if any exist) and the reason for the visit should be reported. Clinical practice guideline abbreviations include: CDC/ACIP – Centers for Disease Control/Advisory Committee on Immunization Practices ICSI – Institute for Clinical Systems Improvement ACS – American Cancer Society Mandate – Mandated by Minnesota statute Blue Cross – Blue Cross and Blue Shield of Minnesota and Blue Plus Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (07/12/12)
Page 1 and 2:
Blue Cross and Blue Shield of Minne
Page 3 and 4:
Recent Chapter changes: Chapter 11
Page 5 and 6:
Chapter 11 - Coding Policies and Gu
Page 7 and 8:
Durable Medical Equipment Date Topi
Page 9 and 10:
Medical Emergency Date Topic Change
Page 11 and 12:
Rehabilitative Services Date Topic
Page 13 and 14:
Table of Contents Chapter 1 At Your
Page 15 and 16:
Introduction Provider Policy and Pr
Page 17 and 18:
How to Contact Us At Your Service P
Page 19 and 20:
At Your Service Claims Address Subm
Page 21 and 22:
Care Management Numbers and Address
Page 23 and 24:
Care Management Numbers and Address
Page 25 and 26:
Company Phone Number Address Public
Page 27 and 28:
At Your Service Provider Identifica
Page 29 and 30:
ID Cards At Your Service Introducti
Page 31 and 32:
Electronic Commerce Overview An imp
Page 33 and 34:
Remote Access Services (continued)
Page 35 and 36:
Provider Communications Provider Co
Page 37 and 38:
Health Plan Members have the Follow
Page 39 and 40:
Provider Agreements Participation a
Page 41 and 42:
Provider Agreements Responsibilitie
Page 43 and 44:
Provider Agreements Provider Number
Page 45 and 46:
Provider Agreements Accounting for
Page 47 and 48:
Provider Agreements Carrier Replace
Page 49 and 50:
Table of Contents Chapter 3 Quality
Page 51 and 52:
Quality Improvement Leadership Rati
Page 53 and 54:
Quality Improvement Telephone Care:
Page 55 and 56:
Quality Improvement Quality of Care
Page 57 and 58:
Quality Improvement Written Policie
Page 59 and 60:
Quality Improvement Written Policie
Page 61 and 62:
Quality Improvement Patient Safety
Page 63 and 64:
Quality Improvement Medical Record
Page 65 and 66:
Quality Improvement Institute for C
Page 67 and 68:
Quality Improvement Quality Improve
Page 69 and 70:
Quality Improvement Physical Facili
Page 71 and 72:
Quality Improvement Treatment Recor
Page 73 and 74:
Page 75 and 76:
Page 77 and 78:
Integrated Health Management Progra
Page 79 and 80:
Integrated Health Management Provid
Page 81 and 82:
Integrated Health Management Utiliz
Page 83 and 84:
Integrated Health Management Medica
Page 85 and 86:
Page 87 and 88:
Integrated Health Management Overvi
Page 89 and 90:
Integrated Health Management Pre-Ce
Page 91 and 92:
Integrated Health Management Decisi
Page 93 and 94:
Integrated Health Management Defini
Page 95 and 96:
Integrated Health Management For Lo
Page 97 and 98:
Integrated Health Management Appeal
Page 99 and 100:
Integrated Health Management Case &
Page 101 and 102:
Integrated Health Management Diseas
Page 103 and 104:
Integrated Health Management Focuse
Page 105 and 106:
Integrated Health Management Specia
Page 107 and 108:
Integrated Health Management Overvi
Page 109 and 110:
Page 111 and 112:
Integrated Health Management Sample
Page 113 and 114:
Health Care Options Prepaid Medical
Page 115 and 116:
Health Care Options Member ID Cards
Page 117 and 118:
Health Care Options Blue Cross and
Page 119 and 120:
Health Care Options Double Gold Dou
Page 121 and 122:
Health Care Options Medicare Basic
Page 123 and 124:
Health Care Options Platinum Blue S
Page 125 and 126:
Health Care Options MedicareBlue PP
Page 127 and 128:
Health Care Options Inquiries and C
Page 129 and 130:
Health Care Options Additional info
Page 131 and 132:
Health Care Options Minnesota Senio
Page 133 and 134:
Health Care Options MinnesotaCare P
Page 135 and 136:
Health Care Options BlueLinkTPA Blu
Page 137 and 138:
Health Care Options Delta Dental Hi
Page 139 and 140:
Health Care Options Prime Therapeut
Page 141 and 142:
Health Care Options Workers' Compen
Page 143 and 144:
Health Care Options HICF 1500 Form
Page 145 and 146:
Health Care Options Networks Blue C
Page 147 and 148:
Blue Plus Member Information Introd
Page 149 and 150:
Blue Plus Member Rights and Respons
Page 151 and 152:
Blue Plus Member Rights and Respons
Page 153 and 154:
Blue Plus Member Benefits Members
Page 155 and 156:
Blue Plus Quality of Care Complaint
Page 157 and 158:
Blue Plus Referral Points Remember
Page 159 and 160:
Blue Plus Referral Not Required We
Page 161 and 162:
Blue Plus Standing Referral Minneso
Page 163 and 164:
Blue Plus Clarifications of Terms (
Page 165 and 166:
Blue Plus [Date] [Name of patient]
Page 167 and 168:
Blue Plus Special Member Benefits O
Page 169 and 170:
Blue Plus OB/GYN Open Access Diagno
Page 171 and 172:
Blue Plus OB/GYN Open Access Diagno
Page 173 and 174:
BlueCard® Claim Status Inquiry ...
Page 175 and 176:
BlueCard® Identifying BlueCard ®
Page 177 and 178:
BlueCard® Identifying BlueCard ®
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
Page 193 and 194:
BlueCard® Guidelines (continued) W
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 and 202:
Claims Filing HCPCS/ Accommodation
Page 203 and 204:
Claims Filing Administrative Simpli
Page 205 and 206:
Claims Filing Claims with Attachmen
Page 207 and 208:
Claims Filing Claims with Coordinat
Page 209 and 210:
Claims Filing Claims with Coordinat
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
Page 239 and 240: Claims Filing Coordination of Benef
Page 241 and 242: Claims Filing TEFRA The 1982 Tax Eq
Page 243 and 244: Claims Filing Employment As defined
Page 245 and 246: Claims Filing Surgical Technicians
Page 247 and 248: Reimbursement / Reconciliation Reim
Page 249 and 250: Reimbursement / Reconciliation Comp
Page 251 and 252: Reimbursement / Reconciliation Remi
Page 253 and 254: Reimbursement / Reconciliation Ques
Page 255 and 256: Reimbursement / Reconciliation Ques
Page 257 and 258: Reimbursement / Reconciliation Acco
Page 259 and 260: Reimbursement / Reconciliation Fiel
Page 261 and 262: Appeals Provider Appeals Introducti
Page 263 and 264: Appeals Submitting Requests for Pos
Page 265 and 266: Appeals Coding Appeals (continued)
Page 267 and 268: Appeals Supporting Documentation (c
Page 269 and 270: Coding Policies and Guidelines (Cod
Page 277: Coding Policies and Guidelines (Cod
Page 301 and 302: Coding Policies and Guidelines (Cop
Page 303 and 304: Coding Policies and Guidelines (Mod
Page 325 and 326: Chapter 11 Coding Policies and Guid
Page 327 and 328: Part-time (Medically Directed) Anes
Page 329 and 330:
Electroconvulsive Treatments Blue C
Page 331 and 332:
Moderate (Conscious) Sedation Monit
Page 333 and 334:
Chapter 11 Coding Policies and Guid
Page 335 and 336:
Coding Policies and Guidelines (Beh
Page 337 and 338:
Coding Restrictions Code Restrictio
Page 339 and 340:
CTSS Skills Training and Developmen
Page 341 and 342:
Intensive Residential Treatment Ser
Page 343 and 344:
IRTS Member Eligibility IRTS Access
Page 345 and 346:
Adult Non-Residential Crisis Servic
Page 347 and 348:
MH-TCM Services to Minnesota Health
Page 349 and 350:
Dialectical Behavioral Therapy/DBT
Page 351 and 352:
Autism Spectrum Disorder/EIBI (cont
Page 353 and 354:
Autism Spectrum Disorder/EIBI (cont
Page 355 and 356:
Psychiatric Consultation to Primary
Page 357 and 358:
Psychiatry and Chemical Dependency
Page 359 and 360:
Medication Management M0064 and 908
Page 361 and 362:
Nutritional Counseling/Medical Nutr
Page 363 and 364:
Page 365 and 366:
Page 367 and 368:
Page 369 and 370:
Practitioner Key MD = Psychiatrist
Page 371 and 372:
Clinical Supervision Under Minnesot
Page 373 and 374:
DIAMOND Initiative (continued) Reim
Page 375 and 376:
Page 377 and 378:
Missed Appointments (continued) Cou
Page 379 and 380:
Guidelines for Court Ordered Evalua
Page 381 and 382:
Guidelines for Court Ordered Evalua
Page 383 and 384:
Page 385 and 386:
Behavioral Health Quality Improveme
Page 387 and 388:
Pre-certification and Concurrent Re
Page 389:
Page 392 and 393:
Page 394 and 395:
Page 396 and 397:
Page 398 and 399:
Page 400 and 401:
Page 402 and 403:
Page 404 and 405:
Page 406 and 407:
Page 408 and 409:
Page 410 and 411:
Page 412 and 413:
Page 414 and 415:
Page 416 and 417:
Page 418 and 419:
Page 420 and 421:
Page 422 and 423:
Page 424 and 425:
Page 426 and 427:
Page 428 and 429:
Page 430 and 431:
Page 432 and 433:
Page 434 and 435:
Page 436 and 437:
Page 438 and 439:
Page 440 and 441:
Coding Policies and Guidelines (Chi
Page 442 and 443:
Page 444 and 445:
Page 446 and 447:
Page 448 and 449:
Page 450 and 451:
Page 452 and 453:
Coding Policies and Guidelines (Den
Page 454 and 455:
Coding Policies and Guidelines (Den
Page 456 and 457:
Page 458 and 459:
Prior Authorization Requirements Co
Page 460 and 461:
Coding Policies and Guidelines (Dur
Page 462 and 463:
Waivers and Upgraded/Deluxe DME Wai
Page 464 and 465:
Page 466 and 467:
Hearing Aids (continued) Website Co
Page 468 and 469:
Portable Oxygen Billing (continued)
Page 470 and 471:
Page 472 and 473:
DME/Supply Internet Purchases Codin
Page 474 and 475:
Page 476 and 477:
Coding Policies and Guidelines (Hom
Page 478 and 479:
Elderly Waiver Program (continued)
Page 480 and 481:
Referrals and Prior Authorization (
Page 482 and 483:
Referrals and Prior Authorization (
Page 484 and 485:
Adult Day Care Bath Services Coding
Page 486 and 487:
Home Infusion (continued) Coding Po
Page 488 and 489:
Coding Policies and Guidelines (Hom
Page 490 and 491:
Rules and Regulations (continued) H
Page 492 and 493:
Hospice Billing for Medicare Produc
Page 494 and 495:
Coding Policies and Guidelines (Hos
Page 496 and 497:
Page 498 and 499:
Page 500 and 501:
Page 502 and 503:
Page 504 and 505:
Coding Policies and Guidelines (Lab
Page 506 and 507:
Papanicolaou Smears (continued) Dia
Page 508 and 509:
Blue Cross and Blue Shield of Minne
Page 510 and 511:
Coding Policies and Guidelines (Mat
Page 512 and 513:
Page 514 and 515:
Page 516 and 517:
Page 518 and 519:
Page 520 and 521:
Coding Policies and Guidelines (Med
Page 522 and 523:
Page 524 and 525:
Page 526 and 527:
Page 528 and 529:
Page 530 and 531:
Page 532 and 533:
Page 534 and 535:
Page 536 and 537:
Page 538 and 539:
Page 540 and 541:
Page 542 and 543:
Page 544 and 545:
Page 546 and 547:
Page 548 and 549:
Page 550 and 551:
Page 552 and 553:
Page 554 and 555:
Page 556 and 557:
Page 558 and 559:
Page 560 and 561:
Page 562 and 563:
Page 564 and 565:
Page 566 and 567:
Page 568 and 569:
Page 570 and 571:
Page 572 and 573:
Page 574 and 575:
Page 576 and 577:
Page 578 and 579:
Page 580 and 581:
Coding Policies and Guidelines (Opt
Page 582 and 583:
Page 584 and 585:
Coding Policies and Guidelines (Pha
Page 586 and 587:
Drugs Coding Policies and Guideline
Page 588 and 589:
Page 590 and 591:
Drug Programs Coding Policies and G
Page 592 and 593:
Page 594 and 595:
Coding Policies and Guidelines (Pub
Page 596 and 597:
Page 598 and 599:
Page 600 and 601:
Page 602 and 603:
Page 604 and 605:
Page 606 and 607:
Page 608 and 609:
Page 610 and 611:
Page 612 and 613:
Page 614 and 615:
Page 616 and 617:
Page 618 and 619:
Page 620 and 621:
Page 622 and 623:
Page 624 and 625:
Coding Policies and Guidelines (Rad
Page 626 and 627:
Page 628 and 629:
Page 630 and 631:
Page 632 and 633:
Physical Therapy Evaluation Codes C
Page 634 and 635:
Hot and Cold Pack Exclusion TMJ Ort
Page 636 and 637:
Massage and Manual Therapy Exclusio
Page 638 and 639:
MHCP PT, OT, ST Authorization Proce
Page 640 and 641:
Page 642 and 643:
Bilateral Services (continued) Codi
Page 644 and 645:
Coding Policies and Guidelines (Sur
Page 646 and 647:
Acne Treatment/ Skin Rejuvenation a
Page 648 and 649:
Liposuction Edit Change Coding Poli
Page 650 and 651:
Assistant Surgeons (continued) Assi
Page 652:
Coding Policies and Guidelines (Sur
show all

Name of Manual - Blue Cross and Blue Shield of Minnesota

Create successful ePaper yourself

Delete template?

Save as template?