Name of Manual - Blue Cross and Blue Shield of Minnesota

Integrated Health Management
Program Goals ..................................................................................................................... 4-24
Referrals to Case and Disease Management ......................................................................... 4-25
Case Management................................................................................................................ 4-25
Referrals to Commercial Case Management .......................................................................4-25
Referrals to Government Programs Case Management....................................................... 4-25
Disease Management ...........................................................................................................4-25
Disease States.......................................................................................................................4-26
Access Management Programs............................................................................................ 4-26
Focused Utilization Review ..................................................................................................... 4-28
Overview..............................................................................................................................4-28
Messages You May Receive................................................................................................ 4-29
Special Investigations ..........................................................................................................4-30
Documentation in the Medical Record .................................................................................. 4-31
Documentation Requirements.............................................................................................. 4-31
Overview..............................................................................................................................4-32
GA Modifier.........................................................................................................................4-33
Medical Referrals To Nonparticipating Providers............................................................... 4-34
Sample Waivers ................................................................................................................... 4-34
Upgraded/Deluxe Durable Medical Equipment (DME)......................................................4-35
DME Waiver Requirement .................................................................................................. 4-35
DME Claims Submissions ................................................................................................... 4-35
Sample DME Waiver...........................................................................................................4-36
4-2 Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (06/19/12)