5/2/17

This Communique provides instruction related to authorizing non-medical EW transportation in the North Eastern areas of Minnesota when using Arrowhead Transit. BluePlus has been working to streamline the process for requesting and authorizing non-medical transportation in those areas of the State that have access to a bus system or other community transportation.

Effective immediately,the process to authorize non-medical, EW Transportation when purchasing a bus pass in those communities that are served by Arrowhead Transit is as follows (examples on pg 2):

  1. Complete a service agreement in Bridgeview using the following:
  2. Request Date
  3. Provider NPI: 1801114301
  4. Service Code “T2003 UC”
  5. “To” and “From” date
  6. List in the Service Description field
  7. New pass OR
  8. Existingpass
  9. Description of Pass
  10. Monthly amount for pass

f. Total units authorized: monthly units multiplied by number of months auth (5900 units x 4 months = 23600)

g. Rate Per Unit: $0.01

h. Total Authorized Amount: total units authorized multiplied by $0.01 (this example is $236.00)

i. Apply Waiver: Yes

j. Prorated: “NO” (this should always be NO)

k. Frequency: “Flexible”

l. Select Provider Reason Code: select appropriate reason code based on your authorization

  1. Complete the appropriate Arrowhead Transit referral form for the bus the member will be using and send DIRECTLY to Arrowhead Transit as indicated on the form. Arrowhead Transit will mail the bus passes directly to the member upon receipt.

New Service agreements will be processed weekly and bus passes will be mailed to each member.

Thank you,

Partner Relations

Below are examples of Service Agreements for bus passes:

Midmonth example: Regardless of the start date being authorized, please create your service agreement based on one month. For example if you want to authorize $70(same as 7000 units) monthlyand you want to start your pass 3/15/17 to 02/28/18, you would multiply your monthly units of 7000 by 12 months ($0.01 per unit) = 84,000 total units authorized. Even though you are starting your service agreement midmonth, you will still authorize the full monthly amount and count it as a full month for purposes of calculating your total units authorized.

Blue Cross® and Blue Shield® of Minnesota is a nonprofit independent licensee of the Blue Cross and Blue Shield Association