Name of Manual - Blue Cross and Blue Shield of Minnesota

Responsibilities of
Participating Providers
(continued)
Provider Agreements
• Submitting preadmission notifications (PANs) or prior
authorizations or pre-certifications when required. PANs must
be submitted through provider web self-service.
• Exceptions to this are:
• non-rehab acute inpatient admissions to Bethesda
Hospital
• admissions for BlueLink TPA members
• if your clinic/facility does not have web access
• For these exceptions only, PANs may be faxed to
(651) 662-6860.
• Referring patients, whenever possible, to other participating
providers including, but not limited to, anesthesiologists,
radiologists, pathologists, surgical assistants and, where
applicable, to Select network providers.
• Accepting payment provisions outlined in the agreement. If
Blue Cross determines that services are experimental,
investigative, or not medically necessary, you may not bill the
patient unless you give the patient written notification of noncoverage
immediately before the services are performed and
the patient agrees in writing to be responsible for the services.
• Notifying Blue Cross of new programs prior to implementation
(i.e., technology, new procedures being performed).
• Maintaining confidentiality of our contractual and financial
arrangements.
• Each provider’s services must be within the scope of the
provider’s registration, license, and training and consistent
with community standards for quality and utilization.
• Not bill Blue Cross for any professional services provided by
physicians and health care professionals to themselves, their
immediate family members or those living in the same
household. Immediate family members include the physician’s
or health care professional’s spouse, children, parents or
siblings.
• Not bill members for missed scheduled appointments except
for a patient who misses a scheduled behavioral health
appointment, provided you have notified the member in
writing in advance that this is your policy. Please note that
PMAP, MinnesotaCare, and Medicare members may not be
billed for missed appointments.
Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (01/05/10) 2-3