Name of Manual - Blue Cross and Blue Shield of Minnesota

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Summary of Changes (2012) Behavioral Health Date Topic Changes 06/20 Coding Restrictions X 06/20 MHCP screening requirements X 06/20 Intensive Residential Treatment Services (IRTS) changed to (Medicaid Government Programs Only) Chiropractic Date Topic Changes Type of Change(s) Content New Topic Deletions Topic Deleted X Type of Change(s) Content New Topic Deletions Topic Deleted 3/6 Effective Date Removed from MHCP Requirements, Page 10 X Dental Services Date Topic Changes 3/6 Electronic Claim Format, Page 3 X Durable Medical Equipment Date Topic Changes 01/17 Medicare Advantage DME Rental Guidelines Waiver Claim Submission Coding Modifiers DME Repairs and Maintenance (Excluding Oxygen Equipment) Billing for Supplies Type of Change(s) Content New Topic Deletions Topic Deleted Type of Change(s) Content New Topic Deletions Topic Deleted Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (08/15/12) 4 X
Durable Medical Equipment Date Topic Changes 03/23 New section/policy re: Enrollment Requirements when Providing Services to MHCP Members Prior authorization: delete "durable medical equipment" DME rental guidelines: large volume air compressors removed Sample waiver form: delete "durable medical equipment" Portable oxygen billing those added, these deleted Coding modifiers: revisions to the LL, RR, NR definitions DME repairs and maintenance (excluding oxygen equipment: add DME, delete "durable medical equipment" Billing for supplies: added "only" to first paragraph; corrected units reporting location; removed references (1500 hicf) claim form Pharmacies submitting DME Claims: delete "durable medical equipment" change to DME 06/20 DME Rental Guidelines X Home Health, Home Infusion, Hospice Date Topic Changes 3/6 PCA modifier information and requirements added, Page 8 X 3/6 Corrected and added coding to grid, Page 10 X 3/6 MHCP PA requirements added, Page 15 X 4/6 Prior Authorization Verbiage updates, Pages 11-2 and 11-14 x 06/20 Home Infusion X Type of Change(s) Content New Topic Deletions Topic Deleted 5 Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (08/15/12) X Type of Change(s) Content New Topic Deletions Topic Deleted
Page 1 and 2: Blue Cross and Blue Shield of Minne
Page 3 and 4: Recent Chapter changes: Chapter 11
Page 5: Chapter 11 - Coding Policies and Gu
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
Page 53 and 54: Quality Improvement Telephone Care:
Page 55 and 56: Quality Improvement Quality of Care
Page 57 and 58:
Quality Improvement Written Policie
Page 59 and 60:
Quality Improvement Written Policie
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Quality Improvement Patient Safety
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Quality Improvement Medical Record
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Quality Improvement Institute for C
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Quality Improvement Quality Improve
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Quality Improvement Physical Facili
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Quality Improvement Treatment Recor
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Page 77 and 78:
Integrated Health Management Progra
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Integrated Health Management Provid
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Integrated Health Management Utiliz
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Integrated Health Management Medica
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Integrated Health Management Overvi
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Integrated Health Management Pre-Ce
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Integrated Health Management Decisi
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Integrated Health Management Defini
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Integrated Health Management For Lo
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Integrated Health Management Appeal
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Integrated Health Management Case &
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Integrated Health Management Diseas
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Integrated Health Management Focuse
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Integrated Health Management Specia
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Integrated Health Management Overvi
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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 (Cop
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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 (Chi
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Coding Policies and Guidelines (Den
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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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Blue Cross and Blue Shield of Minne
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Coding Policies and Guidelines (Mat
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Coding Policies and Guidelines (Med
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Coding Policies and Guidelines (Opt
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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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Coding Policies and Guidelines (Rad
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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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Coding Policies and Guidelines (Sur
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