Medical management overview

The Blue Cross and Blue Shield of Minnesota (Blue Cross) medical and behavioral health policy team develops evidence-based medical and behavioral health policies. 

The team presents medical and behavioral health policies to the Blue Cross Medical and Behavioral Health Policy Committee and the Blue Cross Medical Pharmacy & Therapeutics Committee, which are made up of practicing physicians, pharmacists and other providers representing a variety of specialties and Blue Cross representatives.

Blue Cross requires prior authorization (PA) for some covered admissions, continued stays, services, procedures, drugs and medical devices before they’re covered.

Prior authorization is a review and approval before a service happens to determine whether it’s medically necessary and appropriate. Prior authorization needs vary by the type of health plan the member has.