Name of Manual - Blue Cross and Blue Shield of Minnesota

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Quality Improvement Written Policies (continued) Policy Required Recommended Risk Management Elements Hazardous Materials and Waste Management Infection Control Medical Emergency • Written plan in place and maintained • Hazardous material and waste defined • Mechanism in place for responding to a spill • MSDS (material safety data sheets) available • Hazardous materials and waste are identified and inventoried • Mechanism defined for responding to a spill/breach of containment • Chemical and regulated medical waste addressed • Hazardous gas and vapors addressed • Orientation and education of staff outlined • Basic overview of infection control and how it relates to controlling disease • Hand washing outlined, when and how • Universal precautions addressed, including glove use • Personal protection equipment addressed • Screening employees for TB • Vaccinating employees for Hepatitis B • Steps taken when employee is exposed to breach of infection control or exposure, how to report to OSHA • Mechanism in place for responding • Medical emergency code is identified • Identify who directs activities • Identify who determines if 911 is called 3-10 Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (08/11/11)
Quality Improvement Written Policies (continued) Continuity and Coordination of Care Policy Required Recommended Risk Management Elements Medication Management Non-Medical Emergency Policy Treating Unaccompanied Minors Policy Rationale: • Mechanism in place for procuring, storing, controlling and distributing medications • Narcotics addressed, even if to say they are not kept at the facility • Recalls addressed • Emergency and sample drugs addressed • Sign-out log covered • Prescription pad accessibility addressed • Mechanism in place for responding • Include power outages, weather emergencies, bomb threats, and both fire and fire drills • Minor defined, exceptions covered • Scheduling appointments addressed • Mechanism in place to respond when an unaccompanied minor calls/arrives asking to be seen • Sample of authorization to consent to treatment of a minor is provided Patient continuity and coordination of care (COC) across settings such as inpatient and ambulatory care and transition from specialty to primary care, is critical in ensuring the best care for our members and your patients. All providers share a joint responsibility to ensure continuity and coordination of care. Guidelines: Health Records: • Establish a consistent location(s) for external communications from facilities and/or consultants including but not limited to discharge summaries or notes, consult letters, progress notes, and test or lab results. • Communication is maintained in a chronological order. Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (08/11/11) 3-11
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Blue Cross and Blue Shield of Minne
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Recent Chapter changes: Chapter 11
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Chapter 11 - Coding Policies and Gu
Page 7 and 8: Durable Medical Equipment Date Topi
Page 9 and 10: Medical Emergency Date Topic Change
Page 11 and 12: Rehabilitative Services Date Topic
Page 13 and 14: Table of Contents Chapter 1 At Your
Page 15 and 16: Introduction Provider Policy and Pr
Page 17 and 18: How to Contact Us At Your Service P
Page 19 and 20: At Your Service Claims Address Subm
Page 21 and 22: Care Management Numbers and Address
Page 23 and 24: Care Management Numbers and Address
Page 25 and 26: Company Phone Number Address Public
Page 27 and 28: At Your Service Provider Identifica
Page 29 and 30: ID Cards At Your Service Introducti
Page 31 and 32: Electronic Commerce Overview An imp
Page 33 and 34: Remote Access Services (continued)
Page 35 and 36: Provider Communications Provider Co
Page 37 and 38: Health Plan Members have the Follow
Page 39 and 40: Provider Agreements Participation a
Page 41 and 42: Provider Agreements Responsibilitie
Page 43 and 44: Provider Agreements Provider Number
Page 45 and 46: Provider Agreements Accounting for
Page 47 and 48: Provider Agreements Carrier Replace
Page 49 and 50: Table of Contents Chapter 3 Quality
Page 51 and 52: Quality Improvement Leadership Rati
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Page 55 and 56: Quality Improvement Quality of Care
Page 57: Quality Improvement Written Policie
Page 61 and 62: Quality Improvement Patient Safety
Page 63 and 64: Quality Improvement Medical Record
Page 65 and 66: Quality Improvement Institute for C
Page 67 and 68: Quality Improvement Quality Improve
Page 69 and 70: Quality Improvement Physical Facili
Page 71 and 72: Quality Improvement Treatment Recor
Page 77 and 78: Integrated Health Management Progra
Page 79 and 80: Integrated Health Management Provid
Page 81 and 82: Integrated Health Management Utiliz
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Page 85 and 86: Integrated Health Management Medica
Page 87 and 88: Integrated Health Management Overvi
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Page 91 and 92: Integrated Health Management Decisi
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Integrated Health Management Medica
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Integrated Health Management Sample
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Health Care Options Prepaid Medical
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Health Care Options Member ID Cards
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Health Care Options Blue Cross and
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Health Care Options Double Gold Dou
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Health Care Options Medicare Basic
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Health Care Options Platinum Blue S
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Health Care Options MedicareBlue PP
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Health Care Options Inquiries and C
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Health Care Options Additional info
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Health Care Options Minnesota Senio
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Health Care Options MinnesotaCare P
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Health Care Options BlueLinkTPA Blu
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Health Care Options Delta Dental Hi
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Health Care Options Prime Therapeut
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Health Care Options Workers' Compen
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Health Care Options HICF 1500 Form
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Health Care Options Networks Blue C
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Blue Plus Member Information Introd
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Blue Plus Member Rights and Respons
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Blue Plus Member Rights and Respons
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Blue Plus Member Benefits Members
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Blue Plus Quality of Care Complaint
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Blue Plus Referral Points Remember
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Blue Plus Referral Not Required We
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Blue Plus Standing Referral Minneso
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Blue Plus Clarifications of Terms (
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Blue Plus [Date] [Name of patient]
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Blue Plus Special Member Benefits O
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Blue Plus OB/GYN Open Access Diagno
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Blue Plus OB/GYN Open Access Diagno
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BlueCard® Claim Status Inquiry ...
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BlueCard® Identifying BlueCard ®
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BlueCard® Identifying BlueCard ®
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BlueCard® BlueCard Service Claims
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BlueCard® Prior Authorization and
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BlueCard® Electronic Data Intercha
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BlueCard® Claims Processed by the
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BlueCard® Overview (continued) 3.
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BlueCard® Claim Payment Guidelines
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BlueCard® Calls from Members and O
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BlueCard® Guidelines (continued) W
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BlueCard® Types of Medicare Advant
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BlueCard® Medicare Advantage Claim
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BlueCard® Reimbursement for Medica
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Claims Filing HCPCS/ Accommodation
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Claims Filing Administrative Simpli
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Claims Filing Claims with Attachmen
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Claims Filing Claims with Coordinat
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Claims Filing Claims with Coordinat
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Claims Filing 1500 HICF Form Profes
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Claims Filing Ordering Forms and Ma
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Claims Filing Site of Service (cont
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Claims Filing Institution (837I) /F
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Claims Filing Treatment Room Blue C
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Claims Filing Single facility claim
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Claims Filing Present on Admission
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Claims Filing Medicare Crossover Bl
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Claims Filing Cancel/Void and Repla
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Claims Filing Verifying Patient Eli
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Claims Filing Basic Character Set V
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Claims Filing Rural Health Clinics
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Claims Filing Coordination of Benef
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Claims Filing TEFRA The 1982 Tax Eq
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Claims Filing Employment As defined
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Claims Filing Surgical Technicians
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Reimbursement / Reconciliation Reim
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Reimbursement / Reconciliation Comp
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Reimbursement / Reconciliation Remi
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Reimbursement / Reconciliation Ques
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Reimbursement / Reconciliation Ques
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Reimbursement / Reconciliation Acco
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Reimbursement / Reconciliation Fiel
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Appeals Provider Appeals Introducti
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Appeals Submitting Requests for Pos
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Appeals Coding Appeals (continued)
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Appeals Supporting Documentation (c
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Coding Policies and Guidelines (Cod
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Coding Policies and Guidelines (Mod
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Chapter 11 Coding Policies and Guid
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Part-time (Medically Directed) Anes
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Electroconvulsive Treatments Blue C
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Moderate (Conscious) Sedation Monit
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Coding Policies and Guidelines (Beh
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Coding Restrictions Code Restrictio
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CTSS Skills Training and Developmen
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Intensive Residential Treatment Ser
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IRTS Member Eligibility IRTS Access
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Adult Non-Residential Crisis Servic
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MH-TCM Services to Minnesota Health
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Dialectical Behavioral Therapy/DBT
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Autism Spectrum Disorder/EIBI (cont
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Autism Spectrum Disorder/EIBI (cont
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Psychiatric Consultation to Primary
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Psychiatry and Chemical Dependency
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Medication Management M0064 and 908
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Nutritional Counseling/Medical Nutr
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Practitioner Key MD = Psychiatrist
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Clinical Supervision Under Minnesot
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DIAMOND Initiative (continued) Reim
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Missed Appointments (continued) Cou
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Guidelines for Court Ordered Evalua
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Guidelines for Court Ordered Evalua
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Behavioral Health Quality Improveme
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Pre-certification and Concurrent Re
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Coding Policies and Guidelines (Den
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Prior Authorization Requirements Co
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Coding Policies and Guidelines (Dur
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Waivers and Upgraded/Deluxe DME Wai
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Hearing Aids (continued) Website Co
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Portable Oxygen Billing (continued)
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DME/Supply Internet Purchases Codin
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Coding Policies and Guidelines (Hom
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Elderly Waiver Program (continued)
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Referrals and Prior Authorization (
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Referrals and Prior Authorization (
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Adult Day Care Bath Services Coding
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Home Infusion (continued) Coding Po
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Coding Policies and Guidelines (Hom
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Rules and Regulations (continued) H
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Hospice Billing for Medicare Produc
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Coding Policies and Guidelines (Hos
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Coding Policies and Guidelines (Lab
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Papanicolaou Smears (continued) Dia
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Coding Policies and Guidelines (Mat
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Coding Policies and Guidelines (Pha
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Drugs Coding Policies and Guideline
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Drug Programs Coding Policies and G
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Coding Policies and Guidelines (Pub
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Physical Therapy Evaluation Codes C
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Hot and Cold Pack Exclusion TMJ Ort
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Massage and Manual Therapy Exclusio
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MHCP PT, OT, ST Authorization Proce
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Bilateral Services (continued) Codi
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Coding Policies and Guidelines (Sur
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Acne Treatment/ Skin Rejuvenation a
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Liposuction Edit Change Coding Poli
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Assistant Surgeons (continued) Assi
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