Name of Manual - Blue Cross and Blue Shield of Minnesota

Integrated Health Management
Decision Making and
Notification Time
frames
(Electronic or written)
To ensure timely processing and assist us in meeting compliance
with state and federal guidelines, please submit precertification/authorization
requests at least 15 business days prior
to any elective services being rendered.
File Type Decision-Making Time frame Initial Notification Time frame
(Telephone Practitioner only) Follow-up Notification Time frame
(Members and Practitioners)
Pre-certification Request – Nonurgent:
Initial and Concurrent: Commercial: Within 10 business days* of receiving request, not to exceed 15
calendar days**.
Government Programs: Within 10 business days/14 calendar days, whichever is sooner. Within 1
business day* of making decision and within time frame. Commercial: Within 10 business days* of
receiving request, not to exceed 15 calendar days**.
Government Programs: Within 10 business days/14 calendar days, whichever is sooner
Pre-certification Request – Urgent Commercial: Within 72 hours of receiving request or as
expeditiously as the member's health condition warrants Government: Within 72 hours of receiving
request or as expeditiously as the member's health condition warrants. Same day as decision.
Commercial: Within 72 hours of receiving request or as expeditiously as the member's health condition
warrants. Government: Within 72 hours of receiving request or as expeditiously as the member's health
condition warrants.
Concurrent Review:
Urgent Within 24 hours of receiving request. Applicable to Commercial & Government Programs
business. Within 24 hours of receiving request. Within 24 hours of receiving request. Applicable to
Commercial & Government Programs business.
Post-service Request (Retrospective) Within 30 calendar days** of receiving the request.
Applicable to Commercial & Government Programs business. Within 30 calendar days** of receiving the
request. Within 30 calendar days** of receiving the request. Applicable to Commercial & Government
Programs business.
*Business day: Day in which Blue Cross is open for business, does not include weekends or holidays.
** Calendar day: Days in sequence on calendar, including weekends and holidays
4-16 Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (06/19/12)