Name of Manual - Blue Cross and Blue Shield of Minnesota

Referrals and Prior
Authorization
(continued)
Coding Policies and Guidelines (Home Health, Home Infusion, Hospice)
4. A utilization management nurse will review the request using
the state guidelines for PCA services and make a coverage
determination. A determination will be made within 10 days
from the date the PCA assessment is received by BluePlus.
5. Once a determination has been made, the member, PCA
agency and care coordinator (if applicable) will receive
notification of the amount of services authorized, date spans
covered and an authorization number. If the services have been
denied or reduced, the member’s primary care physician will
also be notified.
Documentation requirements (applies only to providers
employing PCAs)
PCA providers must use a standardized timesheet for all PCAs.
The timesheet must include the following: the start and end time
for each episode of PCA service, the services provided, signature
of the PCA, signature of the member or responsible party, and a
statement that false billing is a federal crime.
PCA individual provider number (applies only to providers
employing PCAs)
DHS assigns Medical Assistance provider numbers to each
individual PCA. Only PCAs who have been issued such a number
by DHS and have evidence of a completed and approved
background study (completed by DHS), shall be considered
eligible providers for the purpose of rendering care to Blue Plus
Minnesota Public Program members. Post-service audits will be
conducted to ensure that the criteria are being met.
When billing an 837P claim format, PCA providers must submit
their individual provider ID in the rendering practitioner fields.
Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (07/12/12)
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