Click Secure Provider Resources (Blue Cross and BCN) on the Resources tab. Click Coronavirus on the Member Care tab. This page provides Blue Cross Blue Shield of Michigan's prior authorization requirements, including information that applies to: Blue Cross commercial and Medicare Plus Blue. Blue Cross commercial only. ©1996-2023 Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association. We provide health insurance in Michigan.Musculoskeletal Services. Providers must obtain authorization from TurningPoint Healthcare Solutions LLC for: Orthopedic procedures. Pain management procedures. Spinal procedures. This requirement applies to BCN commercial and BCN Advantage SM members. For information about musculoskeletal services for Blue Cross commercial …Access this document via ereferrals.bcbsm.com to ensure you're viewing the most up-to-date information. Laboratory For genetic testing and molecular testing ... is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to offer provider portal andereferrals.bcbsm.com. They can also be accessed on the Quick Guides page located in the BCN Provider Publications and Resources website within. Provider ...Access this document via ereferrals.bcbsm.com to ensure you're viewing the most up-to-date information. Palliative care : For non-hospice palliative care and end-of-life decision making : Revised October 2022 : See also: Care management and utilization management programs: Overview for providers 2:Access this document via ereferrals.bcbsm.com to ensure you're viewing the most up-to-date information. Pain management For non-hospice palliative care and ... for Blue Cross Blue Shield of Michigan and Blue Care Network. Title: Blue Cross and BCN - Pain management: For non-hospice palliative care and for musculoskeletal-related pain ...For drugs that require prior authorization, providers should submit requests as follows: For pharmacy benefit drugs, submit requests through CoverMyMeds. Learn about submitting requests electronically and through other methods on Blue Cross Pharmacy Benefit Drugs or on BCN Pharmacy Benefit Drugs. For most medical benefit drugs, including CAR-T ...Blue Cross/BCN Provider Communications Created Date: 20221102132219Z ...U-M Premier Care Therapy Diagnosis Codes ICD-9 …ereferrals.bcbsm.com ...Through our provider portal: Log in to our provider portal ( availity.com *). Click Payer Spaces on the menu bar and then click the BCBSM and BCN logo. Click the eviCore Provider Portal tile on the Applications tab. By logging in directly to the eviCore provider portal at evicore.com *. You can also call eviCore at 1-855-774-1317.you use BCN's e-referral system • If additional visits needed, practitioner completes the revised Outpatient Treatment Authorization form • Visits are authorized based upon: - the number of sessions requested - progress being made toward established goals - use of evidence-based treatment - an appropriate projected therapy end dateMember with BCN coverage who is a Blue Cross employee Phone: 1-888-265-4703 Fax: 1-844-318-5145 Calls are serviced only during business hours (Monday through Friday — except holidays — from 8:30 a.m. to 5 p.m.). Member with BCN HMO or BCN Advantage coverage who is not a Blue Cross employee Call the appropriate Provider Inquiry number:Blue Cross Blue Shield of Michigan and BCN Care Network provide utilization management programs. These programs vary based on member coverage and may be administered by Blue Cross or BCN staff or by contracted vendors. Utilization management programs focus on ensuring that patients get the right care at the rightSkilled Nursing Facility and Acute Inpatient Rehabilitation form for Blue Cross and BCN commercial members. Michigan providers should attach the completed form to the request in the e-referral system. Non-Michigan providers should fax the completed form using the fax numbers on the form. PDF. ... ereferrals.bcbsm.com/questionnaire_lumbar_discectomy_hemilaminectomy_w%20wo_discectomy_foraminotomy.pdf https://www.aetna.com/cpb/medical/data/700_799/0743 ...In mid-May, ereferrals.bcbsm.com is launching a makeover. All the news, forms and information you've come to expect from the site will still be available, but we hope you'll find the new colors and photos more appealing. A new search feature will make the site easier to use. We're also adding a new section for Blue Cross content. Here's a ...Blue Cross Blue Shield of Michigan P.O. Box 33248 Detroit, MI 48232-4248. Area codes: 734, 810, 947, 989 or outside Michigan. Provider Inquiry Blue Cross Blue Shield of Michigan P.O. Box 2227 Detroit, MI 48321-2227. Area codes: 231, 269, 616. Blue Cross Blue Shield of Michigan P.O. Box 230589 Grand Rapids, MI 49523-0589. Area code: 906 ...Click Secure Provider Resources (Blue Cross and BCN) on the Resources tab. Click Coronavirus on the Member Care tab. This page provides Blue Cross Blue Shield of Michigan's prior authorization requirements, including information that applies to: Blue Cross commercial and Medicare Plus Blue. Blue Cross commercial only. • BCN Utilization Management department • eviCore healthcare® Keep reading to learn which members have access to or requirements under these programs. Programs may not apply to all members. This document is subject to change. Access this document via ereferrals.bcbsm.com to ensure you’re viewing the most up-to-date information.Watch for news on system updates, training and other topics at ereferrals.bcbsm.com. *Blue Cross Blue Shield of Michigan doesn't own or control this website. Availity® is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to offer provider portal and electronic data interchange services. W010723BCN commercial and BCN AdvantageSM requests. January 2021 . 1. Check the category that applies to your request: For non-behavioral health facility inpatient admissions: Check one (below), then complete the form and fax it to 1-866-373-9468 or email it to . [email protected]. Note: Effective Jan. 4, 2021, peer-to-peer review requests will notBCN commercial : Fax to 1-866-534-9994 anytime. Behavioral health services : Medicare Plus Blue . Call 1-888-803-4960 anytime. BCN commercial . Call 1-800-482-5982 anytime, for services managed by BCN. BCN Advantage . Call 1-800-431-1059 anytime. Monthly e-referral maintenance (outage) scheduleThe standard BCN ID card layout ID cards for BCN products include the following: > Subscriber Name: Name of the subscriber or member. > Subscriber ID: Alphanumeric identifier composed of a three‑character BCN prefix followed by a BCN‑issued contract number. Use this number for billing and checking eligibility and benefits.management services for Blue Cross Blue Shield of Michigan and Blue Care Network. Quartet is an independent company contracted by Blue Cross Blue Shield of Michigan to connect Blue Cross and BCN members seeking outpatient behavioral health services with the appropriate behavioral health providers.To ensure continued access for current e-referral users. You must login at least once every 90 days to keep you user ID active. If your user ID is not working, please contact Availity ® Client Services at 1-800-AVAILITY (1-800-282-4548).. To sign up as a new e-referral userAdditional referral information appears in the BCN Advantage and Behavioral Health chapters of the manual. The BCN Provider Manual is updated regularly. Updates are designated within the chapters as "Blue Dot" changes. You can identify Blue Dot changes by a blue-dot icon accompanied by a brief explanation of the change in a bold blue text box.BCN's Blue Elect Plus POS webpage on the . ereferrals.bcbsm.com website. For more details about Healthy Blue Choices POS, refer to BCN's Healthy Blue Choices POS webpage. Inpatient services Inpatient admissions: BCN Utilization Man agement must be notified of acute non-behavioral health inpatientFor BCN commercial and BCN Advantage members, call 1-844-377-1278. For Blue Cross commercial and Medicare Plus Blue members, call 1-800-728-8008. If Carelon is unable to accept requests by phone due to technical problems, submit the request to Blue Cross or BCN using one of the following methods: e-referral system unavailable on three May-June weekends (PDF) Qalsody TM to require prior authorization for Medicare Advantage members starting Aug. 1 (PDF) Updated …ereferrals.bcbsm.com website, on these webpages: • Blue Cross Authorization Requirements & Criteria page • BCN Authorization Requirements & Criteria page Here are some additional Blue Cross and BCN holiday closures that will occur during 2023, so you can plan ahead: • Floating Independence Day, Monday, July 3, 2023User Guide - Blue Cross Blue Shield of MichiganMedicare Plus BlueSM, BCN commercial and BCN AdvantageSM Category: Authorizations/referrals Date posted: April 18, 2023 1 . Updated questionnaires in the e-referral system, starting April 24 . On April 24, 2023, we'll update questionnaires in the e-referral system. We'll also update the corresponding preview questionnaires on . ereferrals ...Elect Plus POS, refer to BCN's Blue Elect Plus POS webpage on the ereferrals.bcbsm.com website. Blue Elect Plus POS is available Jan. 1, 2021. Note: As a rule, physicians must follow the authorization requirements that apply to the region in which the headquarters for their medical care group is located.Changes to ereferrals.bcbsm.com Blue Cross commercial, Medicare Plus BlueSM, BCN commercial and BCN AdvantageSM Date posted: October. 12, 2023 1 October 12, 2023: Changes to ereferrals.bcbsm.com We’re changing the ereferrals.bcbsm.com website to make it easier for you to use. OverBCN's Blue Elect Plus POS webpage on the . ereferrals.bcbsm.com website. For more details about Healthy Blue Choices POS, refer to BCN's Healthy Blue Choices POS webpage. Inpatient services Inpatient admissions: BCN Utilization Man agement must be notified of acute non-behavioral health inpatientU-M Premier Care Therapy Diagnosis Codes ICD-9 …ereferrals.bcbsm.com ...Blue Cross Blue Shield of Michigan commercial March 2023 2 . Settings or scenarios . Prior authorization isn't required for services managed by Carelon in the following settings or scenarios: • Inpatient setting • When Blue Cross coverage is secondary — for example, when Blue Cross commercial coverage is secondary to Medicareereferrals.bcbsm.com . Pharmacy benefit . drugs ; Online: Submit through an . electronic prior authorization, or ePA, tool. Alternate methods • Fax: 1-866-601-4425 • Call: 1-800-437-3803 ... Blue Cross Blue Shield of Michigan and Blue Care Network members who have commercial plans.Physicians and professionals: 1-800-344-8525. Hospitals or facilities: 1-800-249-5103. Vision and hearing providers: 1-800-482-4047. Federal Employee Program providers and facilities: 1-800-840-4505. While our automated response system is available to any provider who needs it, we strongly encourage providers to log in or learn how to get an ... ereferrals.bcbsm.com . Pharmacy benefit . drugs ; Online: Submit through an . electronic prior authorization, or ePA, tool. Alternate methods • Fax: 1-866-601-4425 • Call: 1-800-437-3803 ... Blue Cross Blue Shield of Michigan and Blue Care Network members who have commercial plans.View everything Blue Cross Blue Shield of Michigan and Blue Care Network pharmacy related. Access pharmacy resources. Downloadable resources. These documents and materials can help you explain tough topics to your patients. TOOLKIT. Good Health Club. Help encourage children and young adults to be healthy.Online provider search — bcbsm.com has an online provider search that allows you to look for affiliated providers by first selecting the member's Blue Cross or BCN product and then viewing the network choices by type of care and location. More detailed searches are possible by clicking on More Search Options. Once you have located the ... BCN Advantage SM. BCN Commercial Forms. Use the appropriate Medication Authorization Request Form below to request prior authorization for a medication that's covered under a member's medical benefits and administered in an outpatient location. Providers located outside of Michigan who don't have access to the NovoLogix ® online tool must ...Blue Cross Blue Shield of Michigan and Blue Care Network provide a variety of training opportunities to learn about the e-referral system. For information about signing up to use the e-referral system, refer to the Sign up for e-referral or change a user webpage.. We offer the following training resources for the e-referral system:. User guides and documentationTurningPoint reviews this procedure code for BCN commercial and BCN Advantage members for dates of service on or after June 1, 2020, through March 25, 2023. TurningPoint reviews this procedure code for Medicare Plus Blue members for dates of service on or after Jan. 1, 2021, through March 25, 2023. For dates of service on Search for Blue Cross Blue Shield of Michigan and Blue Care Network medical policies, including policies for medical benefit medications. Current and retired/replaced policies are available. Search. For best search results: Do not select category Enter one or more keyword(s) for desired policy or topic Search by keyword or procedure code for ...Carelon-Managed Procedures (formerly AIM) Providers must obtain prior authorization from Carelon Medical Benefits Management (formerly known as AIM Specialty Health ®) for: In-lab sleep studies for BCN commercial members — For dates of service on or after Sept. 1, 2023. Select cardiology and radiology services for BCN commercial and BCN ...Blue Cross Blue Shield of Michigan and Blue Care Network provide a variety of training opportunities to learn about the e-referral system. For information about signing up to use the e-referral system, refer to the Sign up for e-referral or change a user webpage.. We offer the following training resources for the e-referral system:. User guides and documentationAccess this document via ereferrals.bcbsm.com to ensure you’re viewing the most up-to-date information. Blue Cross Coordinated Care CoreSM ... is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to offer provider portal and electronic data interchange services. Title: Blue Cross and BCN ...Click Maintain User under your account in the top navigation or My Account. Dashboard and locate the user’s account. Click the name of the user. Click Revoke User. Select the organization (s) from which you want to revoke the user. If the user belongs to a single organization, that organization is selected by default. A BCN-approved autism analysis evaluation center, or AAEC, participating with the member's health plan, must make or confirm a diagnosis of ASD for the member. Note: If the member has a concern about obtaining an AAEC evaluation, please call BCN Behavioral Health at 1-800-482-5982. The treatment plan prepared by the AAEC must include a ...Procedure codes for which providers must request prior authorization For Blue Cross commercial, Medicare Plus BlueSM, BCN commercial and BCN AdvantageSM v.2023.4 1 . Blue Cross Blue Shield of Michigan and Blue Care Network require health care providers to obtain approval before providing certain services.Call the Blue Cross and BCN Pharmacy Clinical Help Desk at 1-800-437-3803. For Blue Cross commercial members only, mail the request to: Blue Cross Blue Shield of Michigan, Pharmacy Services Mail Code 512B 600 E. Lafayette Blvd. Detroit, MI 48226-2998; Alternate methods for submitting prior authorization requests to CarelonBlue Cross Blue Shield of Michigan and Blue Care Network provide a variety of training opportunities to learn about the e-referral system. For information about signing up to use the e-referral system, refer to the Sign up for e-referral or change a user webpage.. We offer the following training resources for the e-referral system:. User guides and documentationA BCN-approved autism analysis evaluation center, or AAEC, participating with the member's health plan, must make or confirm a diagnosis of ASD for the member. Note: If the member has a concern about obtaining an AAEC evaluation, please call BCN Behavioral Health at 1-800-482-5982. The treatment plan prepared by the AAEC must include a ...SNFs must register for and learn the e-referral system before submitting commercial SNF authorization requests through e-referral starting Dec. 1. e-referral system out of service for maintenance overnight September 19-20. Avoid SNF claim denials for Medicare Advantage by matching PDPM levels on claims to the PDPM levels naviHealth authorized.appropriate BCN region. Complete all fields marked with an asterisk. If you have questions about completing this form, please contact the BCBSM web-DENIS coordinator at 877-258-3932 Type provider's first and last name or facility name here Type provider or facility NPI here In this section, list the names of each provider Go to Page 2 to ...Blue Care Network commercial and BCN AdvantageSM March 2023 1 . This document explains what providers need to do to request a peer-to-peer review with a Blue Cross Blue Shield of Michigan or Blue Care Network medical director about services for which aprior authorization request has been denied by Blue Cross or BCN.To ensure continued access for current e-referral users. You must login at least once every 90 days to keep you user ID active. If your user ID is not working, please contact Availity ® Client Services at 1-800-AVAILITY (1-800-282-4548).. To sign up as a new e-referral userNot signed up for our new provider portal (Availity Essentials) yet? Learn more* about the benefits of registering.. e-referral assistance. Refer to the appropriate e-referral User Guide or Web-based training, available on e-referral, or contact your provider consultant. * Clicking this link means that you're leaving the Blue Cross Blue Shield of Michigan and Blue …Elect Plus POS, refer to BCN's Blue Elect Plus POS webpage on the ereferrals.bcbsm.com website. Blue Elect Plus POS is available Jan. 1, 2021. Note: As a rule, physicians must follow the authorization requirements that apply to the region in which the headquarters for their medical care group is located.BCN Provider Manual. Look in the section titled “Authorization for behavioral health services.” • For Blue Cross commercial and Medicare Plus Blue members, refer to the Behavioral Health webpagen the Blue Cross section of the ereferrals.bcbsm.com website. In additioni , refer to: o Medicare Plus Blue PPO Provider Manual oappropriate BCN region. Complete all fields marked with an asterisk. If you have questions about completing this form, please contact the BCBSM web-DENIS coordinator at 877-258-3932 Type provider's first and last name or facility name here Type provider or facility NPI here In this section, list the names of each provider Go to Page 2 to ...TurningPoint Provider Portal. Refer to BCN's Musculoskeletal Services page at ereferrals.bcbsm.com. • For dates of service prior to July 1, 2020, submit the request to BCN Utilization Management through the e-referral system and must complete the cervical spine surgery questionnaire that opens in the e-referral system.Access this document via ereferrals.bcbsm.com to ensure you're viewing the most up-to-date information. Laboratory For genetic testing and molecular testing ... is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to offer provider portal andQuick Guides. e-referral Quick Guide ( PDF) - A brief overview of what you need to know to start using the e-referral tool. Care management and utilization management programs: Overview for providers ( PDF) - Overview of care management programs for members and utilization management programs for providers. BCN Provider Inquiry Contact ...Updated: Blue Cross continues to pay claims during our union represented employee work stoppage at Blue Cross (PDF) Assisted reproductive technology benefit expanded, starting Jan. 1. 2023 (PDF) Vyvgart Hytrulo to have a site-of-care requirement for most commercial members starting Jan. 1 (PDF) Reminder: Changes for in-lab sleep studies to ... Musculoskeletal Services. . Musculoskeletal Services. Providers must obtain authorization from TurningPoint Healthcare Solutions LLC for: Orthopedic procedures. Pain management procedures. Spinal procedures. This requirement applies to: Blue Cross commercial fully insured groups, select self-funded groups and members with individual coverage*.Carelon-Managed Procedures (formerly AIM) Providers must obtain authorization from Carelon Medical Benefits Management (formerly AIM Specialty Health ®) for the following services: Cardiology services - Medicare Plus Blue SM. This includes cardiac implantable devices and services. High-tech radiology - This includes procedures for Michigan ...ereferrals.bcbsm.com. They are dated May 2022. Blue Cross Blue Shield Blue Care Network @ of Michigan Nonprofit corporations and independent licensees ... Author: Blue Cross Blue Shield of Michigan and Blue Care Network Created Date: 5/24/2022 8:31:08 AM ...For BCN commercial members, fax to 1-866-601-4425. For BCN Advantage members, fax to 1-800-459-8027. Call the Blue Cross and BCN Pharmacy Clinical Help Desk at 1-800-437-3803. For BCN commercial members only, mail the request to: BCBSM Clinical Help Desk.Access this document via ereferrals.bcbsm.com to ensure you're viewing the most up-to-date information. Laboratory For genetic testing and molecular testing ... is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to offer provider portal andTurningPoint reviews this procedure code for BCN commercial and BCN Advantage members for dates of service on or after June 1, 2020, through March 25, 2023. TurningPoint reviews this procedure code for Medicare Plus Blue members for dates of service on or after Jan. 1, 2021, through March 25, 2023. For dates of service onAccess this document via ereferrals.bcbsm.com to ensure you’re viewing the most up-to-date information. Blue Cross Coordinated Care CoreSM ... is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to offer provider portal and electronic data interchange services. Title: Blue Cross and BCN ...Musculoskeletal Services. . Musculoskeletal Services. Providers must obtain authorization from TurningPoint Healthcare Solutions LLC for: Orthopedic procedures. Pain management procedures. Spinal procedures. This requirement applies to: Blue Cross commercial fully insured groups, select self-funded groups and members with individual coverage*. Access the e-referral tool through our provider portal. Log in at availity.com *. Click Payer Spaces at the top. Click the BCBSM BCN logo. Look for e-referral on the Applications tab of our Payer Space.Electronic Commerce. Improve operational efficiency and turnaround time on claims by using electronic transactions for billing, payments, eligibility, and claim status.ereferrals.bcbsm.com. website. *Clicking this link means that you're leaving the Blue Cross Blue Shield of Michigan and Blue Care ... we're not responsible for its content. Availity is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to offer provider portal services. Title:Home page change coming to e-referral, starting Feb. 25. Starting Feb. 25, 2019, e-referral's home-page dashboard will only display new or updated cases from the previous 60 days. This change applies to all Blue Cross Blue Shield of Michigan and Blue Care Network cases in the e-referral system, including commercial and Medicare Advantage.Skilled Nursing Facility and Acute Inpatient Rehabilitation form for, Below are links to documents detailing Blue Care Network's authorization and referra, case pends and BCN cannot authorize it, BCN will contact the provider for additional c, ©2023 – Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees o, e-referral system unavailable on three May-June weekends (PDF) Qalsody TM to require prior , BCN Care Management provider call volumes high. BCN Care Management is exp, BCN Provider Inquiry Contact Information (PDF) - Provider Inquiry phone and fax , A BCN-approved autism analysis evaluation center, or AAEC, parti, • Facilities interested in applying as a BCN-approved autism evalu, Access this document via ereferrals.bcbsm.com to ensure , Blue Cross/BCN Provider Communications Created Date: , Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofi, This requirement applies to all BCN-participating freestand, Carelon Medical Benefits Management is an independent company that co, April 2023. Updated Experimental and investigational se, April 2023. Updated Experimental and investigational ser, BCN Healthy Blue Choices POS. Healthy Blue Choices POS. Hea, healthcare for Blue Cross and BCN. You can submit retroactiv.