Ereferrals bcbsm.

Learn how to request prior authorization for services for Medicare Plus Blue SM PPO and BCN Advantage SM members. Find links to specific services, documents, and resources for non-Michigan providers.• 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 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 right• 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 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 Medicare

Blue Cross Blue Shield of Michigan and Blue Care Network offer care management programs and support services to members. We also 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.Blue Cross Blue Shield of MichiganTime 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.

e-Referral - News Item. SM SM members and all BCN Advantage SM members. We recently published newsletter articles that include information about: The procedures that are affected by the TurningPoint program expansion. Accessing the TurningPoint Provider Portal. Submitting retrospective authorization requests for procedure codes for which ...

June 2018. e-referral system is pending outpatient authorization requests for patients with the Blue Cross Blue Shield of Michigan plans. Updated authorization criteria and e-referral questionnaires are in effect. Effective Oct. 1, Prolia ® and Xgeva ® are subject to a site-of-care requirement for BCN HMO SM members.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 ...BCN Behavioral Health 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 BCN Behavioral Health at 1-877-293-2788. Modifications of InterQual criteria ...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 Medicare

ereferrals.bcbsm.com. They are dated May 2023. What's new • e-referral User Guide: o Long-Term Acute Care Hospital information has been added to the . Submit an Inpatient Authorization . section. You can read more about this change on . Page 32 of the May-June 2023 . BCN Provider News.

Learn how to set up e-referral and Health e-Blue in Availity, submit prior authorization requests for various health services, and access resources for Michigan providers. Find out the latest updates on medical policies, procedures, and utilization management programs.

To see more planned downtimes and to learn how to handle requests while the system is down, review the list of e-referral system planned downtimes and what to do (PDF). You can get to this list anytime from any page of our ereferrals.bcbsm.com website. Scroll down the left navigation pane and look for the blue tile at the bottom.• 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 ®ATTN: BCN Advantage Grievances and Appeals Unit . P.O. Box 284 . Southfield MI 48076-5043 . Fax: 1-866-522-7345 . Phone: 1-800-450-3680 . BCN will process these appeals using the normal BCN Advantage appeal processes for standard and expedited appeals.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.e-Referral - News Item. For dates of service on or after Oct. 1, 2018, AIM Specialty Health will manage the authorization process for cardiology and high-tech radiology procedures for BCN HMO SM (commercial) and BCN Advantage SM members. We first communicated about this in the article AIM Specialty Health to manage cardiology and high-tech ...Additional 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 Behavioral Health Continuing Outpatient Treatment Request Form . Member number: Member name: Member DOB: Goal(s) Example: "Remission of depressive symptoms" Example: "Decreased OCD symptoms" Objective measure(s) (how goal is measured) Example: "PHQ-9", "Beck", "Zung" Example: "Y-BOCS" Targeted discharge outcome(s) / score

Updated Medicare local coverage determination for facet joint injections for Medicare Plus Blue SM and BCN Advantage SM members, starting April 25, 2021. For dates of service on or after April 25, 2021, the updated Medicare local coverage determination for facet joint interventions for pain management (L38841) applies.• See the BCN referral and authorization requirements for Michigan providers document. • See the "Authorization criteria and preview questionnaires" section of the BCN Authorization Requirements & Criteria page on our ereferrals.bcbsm.com website. • See the Utilization Management chapter of the BCN Provider Manual.Carelon Medical Benefits Management is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to manage prior authorizations for select services. For more information, go to our . ereferrals.bcbsm.com. website.by calling 1-844-377-1278 (BCN) or 1-800-728-8008 (Blue Cross) or by logging in to the . Carelon ProviderPortal. See the Medical oncology prior authorization list for Blue Cross and BCN commercial members for a comprehensive list of drugs managed by Carelon, and groups included in the programTo access the forms: 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 Resources tab. Click Secure Provider Resources (Blue Cross and BCN). Click the Forms menu and make the appropriate selection. BCN AdvantageSM. Skilled nursing facilities and home health ... 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. Access this document via ereferrals.bcbsm.com to ensure you're viewing the most up-to-date information. Air ambulance For non-emergency flights Revised September 2023 : ... Blue Cross Blue Shield of Michigan and Blue Care Network Created Date: 9/29/2023 9:45:03 AM ...

For BCN commercial members, fax to 1-877-325-5979. For Medicare Plus Blue members, fax to 1-866-392-6465. Call the Blue Cross and BCN Pharmacy Clinical Help Desk at 1-800-437-3803. For BCN commercial members only, mail the request to: Blue Cross Blue Shield of Michigan, Pharmacy Services Mail Code 512B 600 E. Lafayette Blvd. Detroit, MI 48226-2998For Blue Cross Blue Shield of Michigan on behalf of Blue Cross and Blue Shield Federal Employee Program® Michigan members July 2023 1 . In this document . ... ereferrals.bcbsm.com website. Procedures that require prior authorization by Carelon Radiology (high technology)

In In The provider is in the member's BCN or BCN Advantage network, but not the local network for tiered products. Out Out The provider has NO direct affi liation with the member's product or affi liation with BCN. Servicing Provider Search (User Guide pages 27, 36, 43, 53)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.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. ereferrals.bcbsm.com. Create successful ePaper yourself. Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software. START NOW . Occupational Therapy Treatment Authorization Guide. Introduction. The information contained in this guide serves as an orientation and reference guide to ...e-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 ...ereferrals.bcbsm.com under Blue Cross, then Authorization Requirements & Criteria, then Forms - Blue Cross PPO (commercial)) 2. Fax it to 1-866-373-9468 during normal business hours of 8 a.m. to 5 p.m. ... Blue Cross Blue Shield of Michigan. P.O. Box 321095. Detroit, MI 48232-1095.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.healthcare for Blue Cross and BCN. You can submit retroactive authorization requests to eviCore healthcare ® through July . 29, 2022, for dates of service prior to April 1, 2022. Additional information is available on the . eviCore-Managed Procedures page. in the Blue Cross section at ereferrals.bcbsm.com. Post-acute care servicesTo access it, go to our ereferrals.bcbsm.com website, click Blue Cross or BCN, click Medical Benefit Drugs and look in the "Training resources" section. Using the RC Claim Assist tool Frequently asked questions for providers For Blue Cross commercial, Medicare Plus Blue

Blue Cross Blue Shield of Michigan

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 ...

Shield of Michigan and BCN can contact Availity to get access to Blue Cross and BCN information as if they’re a Michigan provider. Ancillary providers who have taken this step should follow the instructions in the . Michigan . providers: Look up requirements for a member who has coverage through Blue Cross Blue Shield of Michigan ore-referral not available 6 p.m. Friday, April 27, through 6 a.m. Monday, April 30. Several new upgrades and changes are coming to the e-referral system. The biggest change is the combining of BCN and BCBSM e-referral systems into one portal. In order to upgrade the system, e-referral will not be available starting 6 p.m. on Friday, April 27, 2018.BCN Advantage members • Blue Cross and BCN utilization management medical drug list for Blue Cross commercial and BCN commercial members We'll update these lists prior to the effective dates of the change. You can access these lists and other information about requesting prior authorization at : ereferrals.bcbsm.com, at these locations: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.BCN Provider Manual Chapter 16 BlueCaid - e-Referral - BlueBlue Cross/BCN Provider Communications Created Date: 20221027184301Z ...For BCN commercial, call 1-800-482-5982. For BCN Advantage, call 1-800-431-1059. Additional information. As a reminder, you can access resources related to authorizations and referrals on our ereferrals.bcbsm.com website. Click either Blue Cross or BCN and then use the links in the left navigation to reach information related to specific services.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.

September 2023. Changes to preferred drug designations under the medical benefit for most commercial members, starting Jan. 1 (PDF) Management of outpatient diabetes supplies for additional members starting Jan. 1 (PDF) Some diabetes drugs to require prior authorization for Blue Cross and BCN members, starting Jan. 1 (PDF) 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 ...©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.POSTSERVICE CHANGE REQUEST FORM Utilization management toll-free phone: 1-833-217-9670 Utilization management local phone: 313-908-6040 Utilization management fax: 313-879-5509Instagram:https://instagram. a 10 warthog rpmh0544 087ffxiv dravanian forelands aether currentsblack discord banner gif 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 ... concord independent tribune obitsolli at uci May 4, 2015 · 1-800-392-2512. The e- referral User Guide has been created as a tool to instruct new users in the. system’s basic functions and provide some additional suggestions to save time. and avoid errors. Please take a moment to look at the Table of Contents and skim. through the sections to get acquainted with the contents.BCBSM Clinical Help Desk P.O. Box 312320 Detroit, MI 48231-2320 Need additional assistance? Here's who you can call: For questions about utilization management requirements, call the Blue Cross / BCN Pharmacy Clinical Help Desk at 1-800-437-3803. For questions about the CoverMyMeds web tool, call the CoverMyMeds support center … dye stealer meaning BCN 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 not ereferrals.bcbsm.com under Blue Cross, then Authorization Requirements & Criteria, then Forms - Blue Cross PPO (commercial)) 2. Fax it to 1-866-373-9468 during normal business hours of 8 a.m. to 5 p.m. ... Blue Cross Blue Shield of Michigan. P.O. Box 321095. Detroit, MI 48232-1095.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.