Name of Manual - Blue Cross and Blue Shield of Minnesota

Coding Policies and Guidelines (Behavioral Health)
Residential Substance
Abuse Admission and
Concurrent Review
Process Change
(continued)
Pre-certification and
Concurrent Review for
Inpatient/Residential
Mental Health and
Substance Use
Disorder services
11-100
PAN Form
If you have provider web self-service, submit the PAN request
electronically by creating an admission notification on
providerhub.com. A copy of the PAN form is also available on
the Blue Cross website at providers bluecrossmn.com. For
providers that do not have provider web self-service, the PAN
form should be faxed to (651) 662-7006 or called in to
(651) 662-5200 or 1-800-262-0820.
Blue Cross Policy
Failure to comply with the PAN or concurrent review requirements
within 10 business days from the request will result in claims
being denied as provider liability.
To help assure that members receive the appropriate level of care
for mental health and substance use disorder treatment, Blue
Cross, as done with other medical/surgical services, implemented
certain pre-certification and concurrent review protocols for
inpatient/residential services.
This program will continue to expand throughout 2010, and
impacted providers will receive additional information once these
requirements are expanded.
Pre-certification and concurrent review applies to health services
provided to members in fully insured and self-insured benefit
plans, including Minnesota Health Care Programs, with the
exception of Minnesota Senior Care Plus (MSC+), SecureBlue
(HMO SNP), (HMO), Platinum Blue (Cost) and MedicareBlue
PPO (Regional PPO) members. Medicare supplement benefit plans
are also excluded from review. This also does not apply to court
ordered admissions to inpatient/residential treatment. Coverage for
court ordered mental health services is detailed in Minnesota
Statute 62Q.535.
Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual 06/19/12