Name of Manual - Blue Cross and Blue Shield of Minnesota

Integrated Health Management
Appeals Information regarding appeals for denied pre-certification requests
can be found in the Appeals section (Chapter 10) of this manual.
On-site Concurrent
Review
Blue Cross conducts on-site inpatient concurrent review at select
MN hospitals. The goal of the on-site clinical program is to:
Identify members who have been admitted, discharged to home
or to another level of care.
Understand length of stay of member who may be at risk of
hitting outlier status.
Assist members with transition of care needs and bridge the
gap between facility and community.
Engage members in our plan-based case/disease management
activities sooner and more reliably.
Inpatient concurrent review will continue to expand. Although we
will not be on-site at each hospital or inpatient facility, we may be
in contact with you telephonically.
Note: Preadmission notification or certification is required by Blue
Cross. Refer to “Where to Send Requests” for details on
how and where to submit a hospital/inpatient admission.
4-22 Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (06/19/12)