Name of Manual - Blue Cross and Blue Shield of Minnesota

Quality Improvement
Access &
Availability
(continued)
Wait Times
Written Policies Rationale:
• Preventive Care – within 30 days 85% of the time for well
child exam, annual physical exam, etc.
• Routine Primary Care – within 7 days 85% of the time for
non-urgent symptomatic conditions.
• Urgent Care – Same day 85% of the time for medically
necessary care which does not meet the definition of
emergency care.
• Emergency Care – Immediate 100% of the time for
immediately life threatening illnesses, injuries and conditions.
To protect the safety and privacy of all patients, and for the
protection of the provider, Blue Cross requires all providers to
develop and implement written policies and procedures applicable
to the services they provide. Providers are encouraged to have
policies that are facility specific, signed, dated and reviewed
annually.
Requirement:
Each provider will have policies and procedures in place for the
following topics that apply to the services provided in the facility.
Policy Required Recommended Risk Management Elements
Advance
Directives
Child and Teen
Check-ups
• Information made available
• Discussion is documented in medical record
• Copies retained
• Hospitals notified upon admission
• Eligibility defined (birth through age 20,
MA, PMAP, MNCare children)
• Forms for documentation addressed
• Age-appropriate services defined
• Documentation in medical record
• Correct coding
3-8 Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (08/11/11)