Name of Manual - Blue Cross and Blue Shield of Minnesota

Medical and Behavioral
Health Policy
Development
(continued)
Medical Policy and
Behavioral Health
Policy Manual
Integrated Health Management
The drug, device, diagnostic procedure, technology, or medical
treatment or procedure is the subject of ongoing Phase I, II, or III
clinical trials:
Phase I clinical trials determine the safe dosages of medication
for Phase II trials and define acute effects on normal tissue.
Phase II clinical trials determine clinical response in a defined
patient setting. If significant activity is observed in any disease
during Phase II, further clinical trials usually study a
comparison of the experimental treatment with the standard
treatment in Phase III trials. Phase III trials are typically quite
large and require many patients to determine if a treatment
improves outcomes in a large population of patients); or
Medically reasonable conclusions establishing its safety,
effectiveness or effect on health outcomes have not been
established. For purposes of this subparagraph, a drug, device,
diagnostic procedure, technology, or medical treatment or
procedure shall not be considered investigative if reliable
evidence shows that it is safe and effective for the treatment of
a particular patient.
Medical and behavioral health policies are available for your use
and review on the Blue Cross website at
providers.bluecrossmn.com. From this site, there are two ways to
access medical policy information depending on the patient’s Blue
Plan membership.
For Out-of-area Blue Plan Patients
1. Select Medical Policy Pre-Cert/Auth Router
2. Click Go.
You will be taken to the page where you select either medical
policy or pre-certification/prior authorization
3. Enter the patient’s three-letter alpha prefix (as found on their
member ID card)
4. Click Go.
Once you accept the requirements, you will be routed to the
patient’s home plan where you can access medical policy or precertification/pre-authorization
information.
Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (06/19/12) 4-9