How do care coordinators submit an authorization for Blue Plus’s Secure Blue or Blue Advantage member services to Bridgeview? Care Coordinators must enter all service agreements into the Bridgeview system. See the Care Coordination Delegate User Guide for more information. After care coordinators add or update service agreement information, a letter is generated that evening containing all the information entered for the authorization. Bridgeview will post it on the Bridgeview Company website for the provider to view the next business day. Providers can gain access to all their service agreements by logging into the Bridgeview Company website using their Blue Cross assigned User ID number and password. Once logged in the provider will be able to view and or print their service agreements. Provider User ID request forms are listed on the Bridgeview Company website at https://bridgeview.bluecrossmn.com website under the Elderly Waiver public documents link. Providers should complete the form and email to EWProviders@bluecrossmn.com or fax to 218.740.4616.
The service agreement letter will list all the information needed by the provider to render services appropriately. It will also show the prior authorization number that must be included in box 23 when the provider submits claims to Bridgeview.
How do we make changes to the Service Agreement? If care coordinators would like to change or update services, they can make the changes through the Bridgeview web tool and should indicate the reason for doing so by selecting the appropriate reason code. Care coordinators should refer to the Bridgeview Care Coordination Delegate User Guide for step by step instructions.
Can Care Coordinators designate the Waiver Obligation to one specific provider? Care coordinators cannot designate one single provider for a waiver obligation. Member waiver obligation information is determined at the county level and transmitted to Bridgeview from a file that Blue Cross receives from DHS. All service agreements are flagged to have any applicable waiver obligation withheld from payment. The first claim that is transmitted to the claims system for that month will apply the waiver obligation as appropriate. More than one claim per month could be impacted by waiver obligations, depending on the waiver obligation amount.
Does a Service Agreement need to be completed for Blue Advantage MSC+ or SecureBlue MSHO members who are not on EW? No.
How do Providers and Care Coordinators find out Blue Plus members’ ID numbers?
The members’ ID and group number are listed on the Blue Plus member ID card. The Blue Advantage MSC+ member’s alpha prefix of “XZG” and Secure Blue MSHO member’s alpha prefix is “XZS” (the alpha prefix goes in front of the ID#). Blue Advantage MSC+ members’ group numbers will start with “PP0” and Secure Blue MSHO members’ group numbers will start with “PP2”. You do not need to group numbers to bill for services, but you must have the member ID listed on the claim. The member ID is a 9 digit number so do not include the alpha prefix on the claim or any trailing zeros. It should be in the format “801234567”. Providers can also check member eligibility through MN-ITS or EVS system, the subscriber ID is just the member ID number without the “8” in front of it, such as 01234567. You must have two verification criteria such as date of birth and subscriber ID to verify enrollment.
How do care coordination providers, such as counties and clinics, submit Care Coordination claims for Blue Plus Secure Blue MSHO or Blue Advantage MSC+ members? Care Coordination claims should be submitted to Bridgeview via Availity.
Does a Service Agreement need to have the Care Coordination Authorization?
All Care Coordinator time must be billed through Bridgeview for all members, regardless of whether or not the member is on Elderly Waiver program. No service agreement is entered. For members on the Elderly Waiver, the care coordination amount is included in the grand total of all the Medicaid services that count toward the case mix cap for the LTCC & Case Mix date span indicated. The HCPCS codes T1016 UC, T1016 TF UC, T2041, and X5609 (all state plan service such as PCA, HHA, SN, and PDN) should be considered when creating the member’s care plan and those amount count toward the Monthly Service Cap assigned to the member. The grand total would be entered in this section under MA Plan Services in the LTCC & Case Mix section.
Why do Care Coordinators need to put a narrative in the Service Comments on a Service Agreement?
Narratives are required for Extended Equipment/Supplies (T2029), Modifications/Adaption (S5165) and Transitional Services (T2038). In addition, items authorized under these codes are often covered under the member’s Medicare, other insurance, or under the regular Medicaid benefits. All other payers must be billed first before services can be authorized under the EW program for these codes. This is a required field that will only display when you authorize the T2029, S5165 and T2038 services. Those codes are similar to a Not Otherwise Classified or Unlisted/Price by Report procedure code which can represent a variety of items. Therefore, a narrative description is required to outline the specific item or service that is being authorized for the member. You must enter up to 2 lines of comments for these codes which will print on the service agreement letters. The provider must include this same narrative description on the claim that is billed to Bridgeview Company or the claim will reject for missing narrative.
How can Care Coordinators get their billing questions answered?
Care Coordinators can contact Bridgeview Company regarding Service Agreement questions at
EWProviders@bluecrossmn.com or by calling 800-584-9488 or 218-740-2336.
Care Coordinator Providers can contact Bridgeview Company at 1-800-584-9488 or EWProviders@bluecrossmn.com
Member Questions should be directed to: Blue Plus Secure Blue MSHO Member Services: (651) 662-6013 or
888-740-6013. Blue Advantage MSC+ Member Services: (651) 662-8700 or 888-878-0137.
If you need additional information regarding waiver services, please log on to the DHS web site under the provider manual by going to:
www.dhs.state.mn.us
Select the chapter you are interested in, such as home care services, HCBS waiver services, or billing policy, and press the GO button.