Name of Manual - Blue Cross and Blue Shield of Minnesota

Provider Agreements
Carrier Replacement Law
Carrier Replacement The Law
How Carrier
Replacement Works
The Minnesota Carrier Replacement Law applies when a group
terminates their fully insured coverage with one carrier and
replaces it with another fully insured group contract. This law
dictates how Blue Cross determines liability for charges incurred
by a member whose inpatient treatment occurred during this
change in coverage.
• The carrier whose coverage is in effect when a patient is
admitted to a facility is liable for all institutional charges
incurred by a member whose inpatient treatment spans the
change in coverage.
• The carrier in effect at the time of admission is liable for all
professional charges incurred up to the termination date of the
coverage.
• The new carrier is liable for all professional charges incurred
beginning on the effective date of the new coverage.
• The definition of “discharge” is the date the patient is formally
released from the inpatient facility with discharge papers
completed.
Continuous Stay Continuous stay occurs when the patient is sent to another facility
for services unavailable at the current facility and no discharge or
admission papers are processed upon transfer.
• In the case of a patient who is discharged and transferred to
another facility, both the transportation and charges incurred at
the new facility will become the liability of the new carrier.
When… Then…
a new member was hospitalized
prior to the effective date of
Blue Cross coverage
a new member remains
hospitalized on and after the
first date of coverage
the new member’s other carrier
stops paying for the
hospitalization or there is no
other carrier
Blue Cross and Blue Shield of
Minnesota pays the hospital
claim on a pro rata basis
beginning on the date coverage
becomes effective.
2-10 Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (01/05/10)