Medical and behavioral health policies

Learn about medical management and evidence-based coverage criteria here.

View medical and behavioral health policies.

Blue Cross and Blue Shield of Minnesota and Blue Plus (Blue Cross) use a combination of medical and behavioral health policies developed by our team of experts and clinical coverage criteria developed by third-party vendors. To determine the specific criteria and/or source used to determine coverage for a specific type of care, please review our prior authorization requirements.

Policies are about coverage, not recommended care

These medical and behavioral health policies in no way imply that members should not receive specific services based on the provider's recommendation. These policies govern coverage and not clinical practices. Providers are responsible for medical advice and treatment of patients. Members with specific healthcare needs should consult an appropriate healthcare professional.

 

About Blue Cross and Blue Shield of Minnesota medical and behavioral health policies

The 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.
 
The Blue Cross Coverage Committee reviews recommendations from the Blue Cross Clinical Committees. Services, procedures, drugs and medical devices are not covered by Blue Cross until final review and approval by the Blue Cross Coverage Committee.

 

Other evidence-based criteria and guidelines we use and how to access them

 

Other coverage restrictions may apply

Medical and behavioral health policies apply generally to all Blue Cross and Blue Shield of Minnesota and Blue Plus health plans. Benefit plans vary in coverage. Some plans may not provide coverage for certain services noted in the medical policies.

Medicare products, Medicaid products and some self-insured plans may have different policies and prior authorization requirements. Coverage decisions are subject to all terms and conditions of the applicable benefit plan, including specific exclusions and limitations, and to applicable state and/or federal law.

Medical technology assessment submissions

New information about medical technologies addressed in the Blue Cross medical and behavioral health policies may be submitted to the Blue Cross medical policy team for review. Please email the information to medical.technology.assessment@bluecrossmn.com.

Medical policy supporting documents

Blue Cross reserves the right to revise, update and/or add to these policies at any time without notice. If members or providers have questions about a policy, they should contact Blue Cross.

Medical Policy and Pre-Certification / Authorization Router

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