Name of Manual - Blue Cross and Blue Shield of Minnesota

Coding Policies and Guidelines (Behavioral Health)
Referrals Blue Cross does not require a referral for patients seeking care
within the Select Behavioral Health Network. For complete
information on requirements for Minnesota Health Care Programs,
see Chapter 3 of the Blue Plus Manual.
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Services sought outside the Select Behavioral Health Network but
within the Aware network will be processed according to the
patient's self-referral benefit. If the patient has specialty needs,
continuity of care issues, transition of care issues, or cannot access
behavioral health services within the required provider network
within a reasonable time period or due to geographical or physical
accessibility reasons, the provider should contact Blue Cross and
request a referral. A referral may be approved depending on the
patient's situation.
If services are sought outside both the Select network and the
Aware network and the member does not have self-referral
benefits, then Blue Cross should be contacted and the situation
reviewed for a possible referral approval.
Parity Federal and state mandates dictate mental health parity laws that
are applicable to all fully insured groups. Self-insured groups are
not subject to parity legislation, but they may elect to follow these
laws.
Parity means that treatment for substance abuse and/or mental
health is covered the same as any other inpatient and/or outpatient
medical benefit. For example, if a member has coverage for an
illness E/M service from a non-network provider, then that
member will also have coverage for a behavioral health service
from a non-network provider.
Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual 06/19/12