Name of Manual - Blue Cross and Blue Shield of Minnesota

Coding Policies and Guidelines (Behavioral Health)
IRTS Member
Eligibility
IRTS Access to
Services
Billing for IRTS or
Residential Crisis
Court Ordered
Treatment
11-98
Providers are expected to check the member’s eligibility before
rendering services. Resources available for verification include:
MN-ITS
www.mn-its.dhs.state.mn.us
EVS
1-800-657-3613
Provider Web Self-Service
www.providerhub.com
Provider Services
1-800-262-0820
Direct access to contracted providers
No prior authorizations required
No referrals required
Non-contracted providers must obtain a referral from provider
services at 1-800-262-0820 prior to delivering treatment.
When reporting room and board and/or treatment services, report
on the 837I type of bill 86X, with the room and board and
treatment services as separate line items. Submit the room and
board charges under revenue code 1001 and the treatment services
under revenue codes 090X or 091X.
When room and board and treatment are billed to separate entities,
treatment is reported on the 837P, with HCPCS code H0018 or
H0019.
When a court order for treatment is based on an 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) we will consider the order
for treatment 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.
Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual 06/19/12