An overview of initiatives to sustain the highest quality care at the lowest cost.
Our members are at the forefront of everything we do. Blue Cross and Blue Shield of Minnesota (Blue Cross), like many health care providers, is committed to advancing Dr. Donald Berwick’s “Triple Aim” model, which calls on us to improve the health care experience and population health levels, while reducing per capita health care costs.
Collaborating with providers
In partnership with providers, Blue Cross aims to ensure that only the most appropriate care is consistently delivered to our members. Together, payers and providers have a shared responsibility to manage care more efficiently in 2019, with an emphasis on reducing cost variation and overall waste.
Open, transparent communication
We recognize that changes come with the possibility of disruption to established norms in the payer-provider relationship. That’s why Blue Cross has made it a priority to communicate early and often about these changes with providers. We hope to limit confusion and disruption through transparency and open communication.
Initiatives to help sustain quality, lower costs
As a local, nonprofit organization, our mission is to pave the way for everyone to achieve their healthiest life. That means doing what we can to ensure the highest quality care at the lowest possible cost. We’re implementing several initiatives aimed at accomplishing that goal in a more sustainable way.
Emergency Department Level of Service Coding Reimbursement Policy
Genetic/Molecular Lab Test Coding Reimbursement Policy
Hysterectomy Medical Policy for Non-malignant Conditions
Inpatient Non-Reimbursable Unbundling
Preventable Readmissions Reimbursement Policy – Medicare Advantage
Expert partners
As always, our nonprofit mission to make a healthy difference in the lives of our members comes first. By working with organizations with deep expertise in certain areas of health care operations, Blue Cross can more effectively manage changes without sacrificing our focus on members. All partners are thoroughly vetted and approved as an extension of our brand, with Blue Cross maintaining responsibility for all business decisions. Some of these partners include:
Availity online prior authorization tool
With our portal partner, Availity Essentials, we’ve created an online tool for providers to manage the prior authorization (PA) process. This tool allows greater transparency, quicker response time to avoid care delays and lets us implement the care management programs the market demands. Learn more about Availity Essentials and access the tool. You can also check whether a prior authorization is needed with the prior authorization lookup tool.
Amerigroup supports Medicaid management
Amerigroup, an affiliate of Anthem and part of the Blue Cross and Blue Shield Association, is supporting the management of our Medicaid business. This relationship lets us continue our participation in Medicaid while delivering on improved member experience, health outcomes and medical cost goals. Amerigroup has a proven Medicaid track record in 11 other states. Learn more about Amerigroup.
eviCore for specialty utilization management
Our member-centric approach includes assuring that our members’ care is reasonable, necessary and/or appropriate, based on evidence-based clinical standards of care. We believe providers should be reimbursed for services consistent with current scientific data, medical knowledge and clinical practice standards. That’s why we’re working with specialty utilization management vendor, eviCore, to review, approve or deny prior authorizations for select clinical areas. Learn more about eviCore.