Name of Manual - Blue Cross and Blue Shield of Minnesota

Court Ordered
Treatment
(continued)
Preadmission
Notification
Residential Substance
Abuse Admission and
Concurrent Review
Process Change
Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual 06/19/12
Coding Policies and Guidelines (Behavioral Health)
If a participating provider is providing services, a copy of the court
order should be retained in the patient’s chart in the provider’s
office. If the patient sees a nonparticipating provider, a copy of the
court order and MN Universal form should be submitted as soon as
possible so the necessary approval can be entered into the claim
system to ensure accurate payment of any claims. This can be
faxed to Integrated Health Management at (651) 662-0854.
If the court order is to a specific 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 in-network
providers. However, fee-for-service members will be responsible
for the difference between the billed amount and Blue Cross'
allowed amount.
Call (651) 662-2474 or 1-800-262-0820 or fax form X13459 to
(651) 662-0856 to notify Blue Cross of admissions into day
treatment, partial psychiatric or inpatient programs.
PAN Requirements
A PAN is required for all residential substance abuse services,
including services that were previously determined to be halfway
house or extended care. Coverage for services is based on the
specifics of each member’s benefits. The PAN requirement is for
all members who are enrolled in a fully insured plan or Minnesota
Health Care Program.
Concurrent Review
In addition to the PAN requirements, at day 21 of an
inpatient/residential stay, a concurrent review is required with a
medical necessity review. Blue Cross will conduct the medical
necessity review based on an updated completion of the
Department of Human Services (DHS) Dimensions Criteria and
the submission of a current individualized treatment plan. A copy
of the DHS Dimensions Criteria and Assessment is located on the
DHS website at
http://edocs.dhs.state.mn.us/lfserver/Legacy/DHS-2794-ENG.
Blue Cross will not provide courtesy calls to providers notifying
them of missing preadmission notification (PAN) or concurrent
review information. If PAN or concurrent review information is
not received, the claim will deny as provider liability.
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