Name of Manual - Blue Cross and Blue Shield of Minnesota

Missed Appointments
(continued)
Court Ordered
Treatment
Coding Policies and Guidelines (Behavioral Health)
Blue Cross expects behavioral health providers to abide by the
following guidelines:
PMAP, MinnesotaCare and Medicare members cannot be
charged for missed appointments.
Providers must establish a reasonable business policy that
allows for patients not to be charged for failed appointments
due to circumstances outside of their control.
Providers must abide by guidelines established by the
American Medical Association (AMA) and the American
Psychological Association (APA), which state it is ethical for
providers to charge for missed appointments or for
appointments not canceled at least 24 hours in advance, if
patients have been fully advised of the possibility of such
charges.
When a court order for treatment is based on evaluation and
recommendation by a physician, licensed Ph.D. level psychologist,
licensed alcohol and drug dependency counselor, or a certified
chemical dependency assessor (Rule 25), Blue Cross will consider
the order medically necessary.
Blue Cross will provide coverage for these court ordered services
according to the patient’s contract benefits. For example, if the
member does not have inpatient chemical dependency benefits and
the patient is court ordered into inpatient chemical dependency
treatment, there will be no coverage for the services.
Participating providers should maintain a copy of the court order in
the patient’s chart. Nonparticipating providers should fax in the
evaluation and court order to Integrated Health Management at
(651) 662-0854 as soon as possible so that the necessary approval
can be entered into the claim system in time to ensure the claim is
paid accurately.
If the court order specifies a certain non-network provider but the
member does not have any benefits for non-network providers,
Blue Cross will cover the services as they would for any other
network provider. However, fee-for-service members will be
responsible for the difference between the billed amount and Blue
Cross’ allowed amount.
Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual 06/19/12 11-45