Name of Manual - Blue Cross and Blue Shield of Minnesota

Coding Policies and Guidelines (Public Programs)
Hearing Aid Fee
Schedule Update
(continued)
Prior Authorization
If the member requires a hearing aid that is not listed on the DHS
Volume Hearing Aid Purchase Contract, a prior authorization may
be submitted for review of coverage to the Prior Authorization fax
line at (651) 662-2810. Please include the following information in
the request:
Audiologic recommendations, including:
Written recommendations for hearing aid(s), including the
manufacturer specifications
Follow-up plan for determining the effectiveness of the hearing
aid
Audiogram or reason why this was not obtained
History of previous hearing aid use
Pure tone average
Reason why a standard hearing aid on the Volume Hearing Aid
Purchase Contract is not appropriate for this member
GenRx Formulary The drug formulary GenRx will apply for members covered under
Minnesota Health Care Programs.
This new formulary offers drugs that have been shown to be safe
and effective, while being cost conscious. The GenRx formulary
consists of almost all generics, with the exception of a few
generics that were not included on the new formulary due to safety
or efficacy concerns. A limited number of brand-name drugs will
be on formulary to provide appropriate coverage of most disease
states.
11-16
What does this mean for you?
You may need to prescribe a different drug that treats the same
symptoms or condition to an MHCP member. Please be aware that
most of our SecureBlue and CareBlue members have a Medicare
Part D formulary and will not be affected.
Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (02/07/12)