Name of Manual - Blue Cross and Blue Shield of Minnesota

More documents

Recommendations

Info

Coding Policies and Guidelines (Behavioral Health) 11-2 Clinical Supervision Under Minnesota Rule Part 9505.0371 - MHCP Members Only.... 11-39 DIAMOND Initiative ........................................................................................................ 11-40 Marital Counseling ............................................................................................................ 11-41 Opioid Maintenance Drug Therapy................................................................................... 11-41 Tobacco Cessation............................................................................................................. 11-42 Rule 29 Setting .................................................................................................................. 11-43 Day Treatment................................................................................................................... 11-43 Compatibility..................................................................................................................... 11-43 Health and Behavior Assessment and Intervention Codes................................................ 11-44 Missed Appointments........................................................................................................ 11-44 Court Ordered Treatment .................................................................................................. 11-45 Guidelines for Court Ordered Evaluations........................................................................ 11-46 Guidelines for Court Ordered Evaluations – Noncovered Services.................................. 11-49 Parity.................................................................................................................................. 11-51 Behavioral Health Quality Improvement Objectives ........................................................ 11-51 Prior Authorization............................................................................................................ 11-53 Referrals ............................................................................................................................ 11-54 Preadmission Notification ................................................................................................. 11-54 Pre-certification and Concurrent Review for Inpatient/Residential Mental Health and Substance use Disorder Services....................................................................................... 11-55 Groups that Carve Out Behavioral Health Benefits .......................................................... 11-56 Provider Networks............................................................................................................. 11-57 Professional Behavioral Health Coding Information..........................................................11-59 Behavioral Health for Institutional (837I) Billers ...............................................................11-85 Introduction ....................................................................................................................... 11-85 Practitioners Who Should be Using this Section............................................................... 11-85 Coding Guidelines............................................................................................................. 11-85 Behavioral Health Evaluation or Testing .......................................................................... 11-85 Units .................................................................................................................................. 11-85 Individual Behavioral Health Therapy .............................................................................. 11-86 Family and Group Therapy ............................................................................................... 11-86 Substance Abuse Services ................................................................................................. 11-87 Billing a Behavioral Health Assessment ........................................................................... 11-87 Testing ............................................................................................................................... 11-87 Family Therapy ................................................................................................................. 11-87 Nutritional Counseling/ Dietitians..................................................................................... 11-88 Detox and Alcohol/Drug Rehab Services.......................................................................... 11-89 Health and Behavior Assessment and Intervention Codes................................................ 11-89 Non-Residential Treatment Centers .................................................................................. 11-90 FEP Exclusion of Residential Treatment Centers ............................................................. 11-90 Compatibility..................................................................................................................... 11-90 Recreational Therapy......................................................................................................... 11-90 Extended Care and Halfway House Room and Board (Medicaid Government Programs Only).................................................................................................................................. 11-91 Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual 06/19/12
Coding Policies and Guidelines (Behavioral Health) Partial Psychiatric Billing ..................................................................................................11-93 Rule 5 - Emotionally Handicapped Facilities ....................................................................11-95 Children’s Residential Mental Health (Medicaid Government Programs only) ...............11-95 IRTS (Medicaid Government Programs Only)..................................................................11-96 IRTS/Crisis Provider Eligibility ........................................................................................11-97 IRTS Member Eligibility ...................................................................................................11-98 IRTS Access to Services....................................................................................................11-98 Billing for IRTS or Residential Crisis ...............................................................................11-98 Court Ordered Treatment...................................................................................................11-98 Preadmission Notification.................................................................................................. 11-99 Residential Substance Abuse Admission and Concurrent Review Process Change .........11-99 Pre-certification and Concurrent Review for Inpatient/Residential Mental Health and Substance Use Disorder services .....................................................................................11-100 Referrals...........................................................................................................................11-102 Parity................................................................................................................................11-102 Groups that Carve Out Behavioral Health Benefits.........................................................11-103 Provider Networks ........................................................................................................... 11-103 Institutional Behavioral Health Coding Information....................................................... 11-104 Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual 06/19/12 11-3
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 229 and 230:
Page 231 and 232:
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 271 and 272:
Page 273 and 274:
Page 275 and 276:
Page 277 and 278:
Page 279 and 280:
Page 281 and 282:
Page 283 and 284: 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: Chapter 11 Coding Policies and Guid
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: Coding Policies and Guidelines (Beh
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 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 385 and 386:
Behavioral Health Quality Improveme
Page 387 and 388:
Pre-certification and Concurrent Re
Page 389:
Coding Policies and Guidelines (Beh
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:
Chapter 11 Coding Policies and Guid
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

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?