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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 ...

TurningPoint 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 Below are links to documents detailing Blue Care Network's authorization and referral requirements for services managed by BCN, including lists of procedures that require authorization and authorization criteria and preview questionnaires for various procedures. These apply to services other than drugs covered under the medical benefit.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 ...Enable Javascript support in the browser.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, …POSTSERVICE CHANGE REQUEST FORM Utilization management toll-free phone: 1-833-217-9670 Utilization management local phone: 313-908-6040 Utilization management fax: 313-879-5509Trogarzo TM and Zilretta ® require authorization for commercial members starting Oct. 1. For dates of service on or after Oct. 1, 2018, Trogarzo and Zilretta will be added to the medical drug prior authorization program for Blue Cross PPO (commercial) and BCN HMO SM (commercial) members.. Trogarzo will also be subject to a site-of-care requirement for BCN HMO (commercial) members only ...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 and Medicare Plus ...

• 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.©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.bcbsm.com, ereferrals.bcbsm.com, MiBlueCrossComplete.com, mibluesperspectives.com, ahealthiermichigan.org and valuepartnerships.com. Blue Cross, Blue Care Network and Blue Cross Complete do not control any other websites referenced in . this publication or endorse their general content.Below are links to documents detailing Blue Care Network's authorization and referral requirements for services managed by BCN, including lists of procedures that require authorization and authorization criteria and preview questionnaires for various procedures. These apply to services other than drugs covered under the medical benefit.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 ...BCN Provider Resource Guide - e-Referral - Home. BCN Provider Resource Guide Behavioral Health Welcome to the BCN Provider Resource Guide!Benefits and Eligibility In this Guide you will find contact information for many of the services that BCN offers Care Management and for the functions you most frequently perform in servicing BCN members. Chronic Condition Use the navigation bar at the left ...Register. Create a delegate or prescriber account to start processing prior authorizations today. Register. Surescripts does not store or maintain information of portal transactions …BCN Care Management provider call volumes high. BCN Care Management is experiencing high call volumes. To avoid waiting on the phone line, providers should use BCN's e-referral system to submit or check the status of referrals or requests for clinical review.We encourage providers to call the Medical Information Specialist line at 1-800-392-2512 with urgent requests only.

BCN HMO SM; BCN Advantage SM; Endovascular intervention, peripheral artery: New codes: *34101, *34111, *34151, *34201, *34203, *37184 and *37222 ... The updated authorization criteria and preview questionnaires are available at ereferrals.bcbsm.com. Here's where to find them: For BCN documents - Click BCN, then click Authorization Requirements ...Time is running out to give us your opinion on provider training. You have until July 31 to complete our online survey. Your response will help us improve the way we distribute information to you. Thank you for your time and your input. Posted: July 2018. Lines of business: Blue Cross Blue Shield of Michigan and Blue Care Network.1 day ago · 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. Over Blue Cross Blue Shield of MichiganBlue Cross Blue Shield of Michigan P.O. Box 32593 Detroit, MI 48232-0593. UB-04 claims Blue Cross Blue Shield of Michigan P.O. Box 310166 Detroit, MI 48231-0166. Federal Employee Program claims Blue Cross Blue Shield of Michigan P.O. Box 312599 Detroit, MI 48231-2599. Blue Cross Complete claims P.O. Box 7355 London, KY 40742

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Autism services : Billing guideline s and procedu re codes For Blue Cross commercial and Blue Care Network commercial Revised May 2023 . 1 . This document outlines activities, codes and rates for autism services, along with information about billing and documentation.Hospital NPIs (for Medical Referrals/ Authorizations) May 2019 Provider Name NPI Aleda E. Lutz VA Medical Center 1164471066 Allegan General Hospital 1295803377PAIN MANAGEMENT EPIDURAL STEROID INJECTIONS AUTHORIZATION REQUEST FORM Utilization management toll-free phone: 1-833-217-9670 Utilization management local phone: 313-908-6040In 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 ...

referral is required for BCN commercial members whose primary care provider is part of a medical care group based in the East or Southeast region. Note: For dates of service before Jan. 1, 2022, post-service authorization is required for all members. For additional information, refer to BCN's Bariatric Surgery webpage at ereferrals.bcbsm.com.BCN Care Management provider call volumes high. BCN Care Management is experiencing high call volumes. To avoid waiting on the phone line, providers should use BCN's e-referral system to submit or check the status of referrals or requests for clinical review.We encourage providers to call the Medical Information Specialist line at 1-800-392-2512 with urgent requests only.Additional updated authorization criteria and e-referral questionnaires. We're making updates to the authorization criteria and questionnaires in the e-referral system, for the following services: Cholecystectomy (laparoscopic) for adults. Endoscopy, upper gastrointestinal, for gastroesophageal reflux disease. Hyperbaric oxygen therapy.For Blue Care Network commercial and BCN AdvantageSM Effective Aug. 27, 2023 . 1 . Responsive neurostimulator/deep brain stimulation trigger We provide coveragefor this procedure for pediatric and adultmembers who meet medical necessity criteria. Submit authorization requests through the e-referral system.Behavioral health medical record documentation requirements and privacy regulations — for services other than ABA page 4 September 2017 For Blue Cross PPO (commercial), Blue Cross Medicare Plus BlueSM PPO, Blue Care Network HMOSM (commercial) and BCN AdvantageSM members HIPAA privacy regulations and documentation — for all non-ABA services by all practitionersfor pediatric and adult Blue Care Network commercial and BCN Advantage members. We also updated the corresponding preview questionnaire on the . ereferrals.bcbsm.com. website. As a reminder, we use our authorization criteria, our medical policies and your answers to the questionnaires in the e-referral system when making utilization managementBCN Provider Inquiry Contact Information (PDF) - Provider Inquiry phone and fax numbers for all BCN products. Provider resource guide at a glance (PDF) Summary of key contact information. This summary document helps providers keep phone and fax numbers at their fingertips and is updated as needed, so that the most current information is always ...POSTSERVICE CHANGE REQUEST FORM Utilization management toll-free phone: 1-833-217-9670 Utilization management local phone: 313-908-6040 Utilization management fax: 313-879-5509PAIN MANAGEMENT EPIDURAL STEROID INJECTIONS AUTHORIZATION REQUEST FORM Utilization management toll-free phone: 1-833-217-9670 Utilization management local phone: 313-908-6040e-referral Provider Search feature — Within the e-referral tool, you can search by provider name or national provider identifier. When you have a member selected and then go to select a provider, the system will indicate if the provider is "in" or "out" of network for that member. For more information, see: e-referral User Guide ( PDF) Online ... Not 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 …

TurningPoint 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

This requirement applies to all BCN-participating freestanding diagnostic facilities, outpatient hospital settings, ambulatory surgery centers and provider offices that provide these services, for BCN commercial and BCN Advantage members (except for physical medicineAccess this document via ereferrals.bcbsm.com to ensure you're viewing the most up-to-date information. Air ambulance : For non-emergency flights : ... Availity is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to offer provider portal services.Some services for Medicare Plus Blue SM PPO and BCN Advantage SM members require practitioners and facilities work with us or with one of our contracted vendors to request prior authorization before beginning treatment.. Prior authorization requirements. See the links within the accordions for information on prior authorization requirements for specific services.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. website. As a reminder, we use our authorization criteria, our medical policies and your answers to the questionnaires in the e-referral system when making utilization management determinations on your prior authorization requests. New questionnaire . We'll add the following questionnaire to the e-referral system: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 documentationMusculoskeletal 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 and–Articles in BCN Provider News –Web-DENIS messages –One excellent place to go for information is ereferrals.bcbsm.com. Click Radiology Management. Note: ...

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Blue Care Network commercial and BCN AdvantageSM Revised January 2022 To request the criteria used in making a determination on a specific authorization request : 1. Complete every field below. 2. Fax the completed form to 1 -866 373 9468. This applies only to non-behavioral health authorization requests for which the Blue Cross and BCNNot applicable BCN commercial and BCN Advantage Not applicable Can the provider bill under supervision? Yes . Note: If billing under a fully licensed psychologist or under a physician (MD/DO), the supervising provider's NPI must be used and the appropriate modifier (HO or AJ) is required. No Yes, but the provider must be in an OPC and:Access this document via ereferrals.bcbsm.com to ensure you're viewing the most up-to-date information. Advance care planning ... management services for Blue Cross Blue Shield of Michigan and Blue Care Network members who have Medicare Advantage plans. Title: Blue Cross and BCN - Advance care planning: For end-of-life decision making and ...one month, call BCN Behavioral Health at 1-800-482-5982. 4. What if I have trouble completing the questionnaire within the e-referral system? As an alternative, you can complete the relevant form on the . Behavioral Health page in the BCN section at . ereferrals.bcbsm.com. and attach it to your authorization request within the e-referral system.Important: For Blue Cross Blue Shield of Michigan commercial and Blue Care Network commercial members, Michigan’s prior authorization law* requires health care providers to submit prior authorization requests electronically. If you’re experiencing temporary technical problems, such as a power system or internet outage, you can submit ...• BCN Medical-Benefit Drugs If you need help with the NovoLogix tool, contact the Web Support Help Desk at 1-877-258-3932. *Clicking this link means that you're leaving the Blue Cross Blue Shield of Michigan and Blue Care Network website. While we recommend this site, we're not responsible for its content. Availity ®We'll also make these lists available at ereferrals.bcbsm.com: On the Blue Cross Medical Benefit Drugs page; On the BCN Medical Benefit Drugs page; You'll also be able to find these lists behind the provider portal. We appreciate the feedback we received from the provider community and encourage additional comments on the new documents.PAIN MANAGEMENT EPIDURAL STEROID INJECTIONS AUTHORIZATION REQUEST FORM Utilization management toll-free phone: 1-833-217-9670 Utilization management local phone: 313-908-6040 For Medicare Plus Blue members, fax to 1-866-601-4428. 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: BCBSM Clinical Help Desk. P.O. Box 312320.For 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: • BCN Medical-Benefit Drugs If you need help with the NovoLogix tool, contact the Web Support Help Desk at 1-877-258-3932. *Clicking this link means that you’re leaving the Blue Cross Blue Shield of Michigan and Blue Care Network website. While we recommend this site, we’re not responsible for its content. Availity ® ….

Blue Care Network commercial and BCN Advantage. SM. Clinical review is required for adult members (age ≥18). The medical necessity criteria are outlined below. CPT codes: *93653, *93654 and *93656. Atrial fibrillation (AF) by ECG . One of the following must be met: 1. Paroxysmal atrial fibrillation and ALL: a. Must have one of the following ...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*.This document describes the referral and plan notification requirements that apply to Blue Cross Blue Shield of Michigan and Blue Care Network members. It also summarizes the types of procedures and services that require authorization for Blue Cross Blue Shield of Michigan and BCN members and indicates which entity manages the authorizations.©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.Blue Cross Blue Shield of Michigan and Blue 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 theAdvantages of using the e-referral system for prior authorization requests instead of calling or faxing. Using the e-referral system is the most efficient way to submit a prior authorization request for services managed by the Blue Cross Blue Shield of Michigan and Blue Care Network Utilization Management departments.• BCN Medical-Benefit Drugs If you need help with the NovoLogix tool, contact the Web Support Help Desk at 1-877-258-3932. *Clicking this link means that you’re leaving the Blue Cross Blue Shield of Michigan and Blue Care Network website. While we recommend this site, we’re not responsible for its content. Availity ®- For Blue Cross and BCN members in groups subject to the mandate, benefits went into effect Oct. 15, 2012. - The Oct. 15, 2012, effective date did not apply to all groups. Blue Cross and BCN groups not subject to the mandate have the option to offer the mandated autism benefit. • Find more information about the autism• 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.Medicare Plus Blue uses Change Healthcare's InterQual Behavioral Health Criteria as utilization management guidelines subject to the modifications posted below. To request a copy of the specific InterQual criteria used to make a decision on a member's case, call Medicare Plus Blue Behavioral Health at 1-888-803-4960. Ereferrals.bcbsm, [text-1-1], [text-1-1], [text-1-1], [text-1-1], [text-1-1], [text-1-1], [text-1-1], [text-1-1], [text-1-1], [text-1-1], [text-1-1], [text-1-1], [text-1-1], [text-1-1], [text-1-1], [text-1-1], [text-1-1], [text-1-1], [text-1-1], [text-1-1], [text-1-1], [text-1-1], [text-1-1], [text-1-1], [text-1-1], [text-1-1], [text-1-1], [text-1-1], [text-1-1], [text-1-1], [text-1-1], [text-1-1], [text-1-1]