BCBS of Minnesota Reviewing for Medical Necessity

On June 3, 2019, Blue Cross and Blue Shield (BCBS) of Minnesota removed the prior authorization (PA) requirements for outpatient therapies, including physical, occupational, and speech therapy, and chiropractic services. Self-Insured Groups may have benefits that require a PA for outpatient therapy or chiropractic services. These services may be managed as a PA or a retrospective review.

While the above is good news, with the removal of the PA, BCBS of Minnesota will be conducting medical necessity review of services. The number of visits outlined below provides an example of when Blue Cross would typically begin reviewing therapies for medical necessity at point of claim.

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