Blue Plus is the HMO through which Blue Cross and Blue Shield of Minnesota serves Minnesota Health Care Programs members (Families and Children Medical Assistance and MinnesotaCare). For ABA it runs the state’s EIDBI benefit rather than its own autism policy: Blue Cross’s medical policy X-43 says Medicaid products "may provide different coverage" and points to the MHCP manual. Authorization, claims and contracting run through Blue Cross’s public-programs provider services.
Blue Cross’s EIDBI bulletins (2020–2021, still the current notices on its site) set the process: the completed ITP is required "as part of the initial, 6-month, and annual authorization requests"; the ITP, CMDE and a completed Blue Cross EIDBI Request Form go by fax to 1-800-505-1193 or as an attachment in Availity’s Interactive Care Reviewer; and since April 1, 2021 Blue Cross uses "a 180-day time span for EIDBI service authorization requests. Requests that exceed 180 days will be reduced." Since December 1, 2021 every EIDBI code (0373T, 97151, 97153–97157, H0032, H0046, T1024) must carry the UB modifier, matching DHS’s billing grid. DHS’s October 2026 MCO grid confirms "No referral is required for the service. Services do require authorization," that non-contracted providers need authorization for everything, and that "All claims must be submitted electronically using Availity."[2][1][4][3][13][14]
Filing limits: Blue Cross’s bulletin P74-22 made 180 days the claims timely filing limit "for all lines of business" from February 1, 2023, with appeals due within 90 days, and its January 2024 MHCP migration FAQ (for Blue Plus Medicaid) repeats it: "Timely filing is 180 days from the date of service for claims and 90 days from remit date for appeals." Neither document sets a separate corrected-claim or secondary-claim window or a check-run schedule; ask MHCP provider services, 1-866-518-8448.[2][1][4][3][13][14]
Because EIDBI is a statutory Medical Assistance benefit, the rules in § 256B.0949 bind Blue Plus members as well: under 21, CMDE before treatment, a QSP-supervised ITP, at least one hour of clinical supervision per 16 hours of direct treatment, monthly QSP observation and direction, and (from 2026) documentation signed with credentials and entered within 72 hours. Since January 1, 2026 the Minnesota Utilization Review Act applies to Medical Assistance managed care (§ 62M.01, subd. 3(b)), so standard authorization decisions are due within five business days of a complete request. DHS’s MHCP manual also tells MCOs to identify and credential all Level I, II, III and QSP providers from DHS’s enrollment data and to decide within 45 days of a clean application.[5][6][9][10][7]
The questions that decide whether a family can start with Blue Plus (Blue Cross and Blue Shield of Minnesota) — Medical Assistance, and what they have to bring. Each maps onto something intake should ask on the first call.
Under 21. The statute defines the covered "person" as "an individual under 21 years of age" (§ 256B.0949, subd. 2(q)), and DHS lists "Younger than age 21" among the eligibility criteria.[5][17]
Blue Plus requires the ITP at the initial, 6-month and annual requests. The CMDE clock is DHS’s: updated at least every three years, and the annual CMDE is part of the reauthorization cycle.[2][18]
Set by statute: the diagnosis of ASD or a related condition must be "completed by either (i) a licensed physician, advanced practice registered nurse, or physician assistant, or (ii) a mental health professional," be based on current DSM criteria with direct observation and caregiver information, and meet the standard diagnostic assessment rules of § 245I.10, subd. 6 (§ 256B.0949, subd. 4). DHS’s eligibility page says assessors use the DC:0-5 for children five and younger and the DSM from age six. The CMDE provider (physician, APRN, PA, mental health professional, or qualified clinical trainee with 2,000 hours of ASD experience or equivalent coursework) then confirms medical necessity.[5][17]
No instrument is mandated for EIDBI itself: DHS "strongly encourages providers to use standardized assessment tools" but "does not require specific assessment tools." The exception is a CMDE submitted for other disability or benefit decisions (waiver enrollment, SSI): there DHS requires "A direct observational assessment (e.g., ADOS-2)" and "A structured caregiver interview (e.g., ADI-R)," and says developmental history or non-autism-specific screens alone are "insufficient."[17][18]
No. DHS’s October 2026 grid, for Blue Cross and Blue Shield of Minnesota: "No referral is required for the service. Services do require authorization."[4]
Blue Plus publishes no EIDBI telehealth rule of its own. Yes, for most EIDBI services. The statute says Medical Assistance "covers medically necessary EIDBI services and consultations delivered via telehealth … in the same manner as if the service or consultation was delivered in person" (§ 256B.0949, subd. 13(l)). DHS lists the CMDE (97151), coordinated care conference, family/caregiver training (97156/97157), ITP development and progress monitoring (H0032), individual and group intervention (97153/97154) and observation and direction (97155) as telehealth-eligible; higher-intensity intervention (0373T) "cannot occur via telehealth." Same thresholds, authorization and rates as in person; QSP observation and direction may be remote for at most two consecutive months. Bill POS 02 (not at home) or POS 10 (at home), modifier 93 for audio-only, and never use telehealth POS or modifiers for non-client-facing services. Providers enroll for telehealth on the Telehealth Provider Assurance Statement (DHS-6806).[5][19][20]
Blue Plus publishes no EIDBI decision clock. State and federal law apply: since January 1, 2026 standard determinations are due within five business days of a complete request and expedited ones within 48 hours including a business day (§§ 62M.01, subd. 3(b), 62M.05), inside the federal 7-calendar-day ceiling for rating periods from January 1, 2026 (42 CFR 438.210(d)). Authorizations span up to 180 days.[9][10][11][1]
Medical Assistance is still the payer of last resort, but EIDBI is "pay and chase." DHS: "EIDBI providers are not required to bill a member’s commercial insurance before billing Medicaid. MHCP or the MCO will seek reimbursement from third parties … This ‘pay and chase’ process applies to both fee-for-service and managed care members," though a payment received from another source must still be reported. That matches the federal rule letting states pay EPSDT claims and recover later (42 CFR 433.139(b)(3)(i)). For authorization, DHS tells providers with privately insured members to "follow the primary insurance’s authorization procedures."[7][12]
Coverage decides whether Blue Plus (Blue Cross and Blue Shield of Minnesota) — Medical Assistance pays. These decide whether the claim survives: how sessions must be staffed and supervised, what may be billed concurrently, the per-day ceilings, who signs the note, where the service is payable, and whose NPI the claim goes out under.
Blue Plus publishes no EIDBI supervision rule of its own. Set by statute for every Medical Assistance member, fee-for-service or managed care. An EIDBI agency must "provide clinical supervision for a minimum of one hour for every 16 hours of direct treatment per person, unless otherwise authorized in the person’s individual treatment plan," and must provide "the required EIDBI intervention observation and direction by a QSP at least once per month" (Minn. Stat. § 256B.0949, subd. 16(a)(15)–(16), as amended by Laws 2026, ch. 95). The QSP may do that monthly observation and direction by telehealth for no more than two consecutive months; the third month must be in person. DHS’s clinical supervision page (updated 9/15/26) adds that each person gets one primary QSP (who signs the ITP), a backup QSP must be available, and a different ratio needs an exception documented in the ITP and approved through service authorization. Every intervention must be "provided by a qualified EIDBI provider and supervised by a QSP" (subd. 13(a)).[5][6][15][1]
Blue Plus aligns with DHS’s billing grid ("Blue Cross is aligning with the DHS Claims guidelines published in the EIDBI Billing Grid"), so the grid’s daily limits apply: 97153 and 0373T 8 hours, 97154 4.5 hours, 97155 6 hours, 97156/97157 4 hours, 97151 8 hours a day and 80 units a year.[1][8]
Blue Plus publishes no EIDBI note rule of its own. Statutory since 2026. New subdivision 19 of § 256B.0949 (Laws 2026, ch. 95, art. 4, sec. 26) requires all CMDE and EIDBI documentation to be "signed and dated by the provider completing the documentation with the provider’s full name, title, and credentials," to "be entered within 72 hours of service and contain a record and explanation of any delays in entry," and to "include a record of supervision and oversight for staff providing services requiring supervision." "Each EIDBI service occurrence must be documented in a progress note." DHS-7108 (CMDE) must be signed by the CMDE provider and the caregiver or guardian, and DHS-7109 (ITP) by the QSP and the caregiver or guardian; those signatures are the family’s consent to start or continue services.[6][16]
Blue Plus says EIDBI claims "should continue to match the guidelines outlined by DHS," but publishes no simultaneous-billing rule of its own. Under DHS policy two providers may bill 97153 and 97155 for the same time when medically necessary.[1][16]
Ask the plan: Blue Cross MHCP Provider Services, 1-866-518-8448: ask whether Blue Plus applies DHS’s simultaneous-services rule to 97153 with 97155.
Blue Plus publishes no EIDBI setting rule. Under DHS policy EIDBI may be delivered in a center, clinic, office, or home or community (POS 12 community, POS 11 office), not in place of school instruction.[16][7]
Ask the plan: Blue Cross MHCP Provider Services, 1-866-518-8448: confirm accepted POS codes for EIDBI.
Not stated by Blue Plus beyond the UB-modifier rule. DHS requires the rendering provider and the supervising QSP on EIDBI claims; ask whether Blue Plus enforces the same loops.[1][7]
Ask the plan: Blue Cross MHCP Provider Services, 1-866-518-8448, or Availity claim guidance for EIDBI.
180 days from the date of service, and 90 days from the remit date for appeals (Blue Cross bulletin P74-22 and its 2024 MHCP FAQ). No separate corrected- or secondary-claim window or check-run schedule is published.
Yes, through the state EIDBI benefit for members under 21. Blue Plus follows DHS’s EIDBI guidelines and requires prior authorization of treatment.
Attach the CMDE, ITP and Blue Cross EIDBI Request Form in Availity’s Interactive Care Reviewer, or fax them to 1-800-505-1193. Authorizations span up to 180 days.
No. Blue Plus is Blue Cross’s public-programs HMO; Blue Cross commercial members follow medical policy X-43 and their benefit plan.
Payer policies change frequently and vary by plan, state, and funding type. This guide was compiled from the sources above and last reviewed October 2026; it is general information, not billing, legal, or clinical advice. Always verify current requirements against the payer's live policy and a benefits check for the specific member.
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