Ereferrals.bcbsm - requests for BCN members Skilled nursing facilities that submit prior authorization requests for physical, occupational or speech therapy for BCN commercial or BCN Advantage members in a Basic bed should submit the request to BCN Utilization Management through the e-referral system. Don’t submit the request to eviCore …

 
Ereferrals.bcbsmEreferrals.bcbsm - For Blue Cross PPO (commercial) behavioral health requirements, see the For Blue Cross PPO (commercial) members section on ereferrals.bcbsm.com under Blue Cross then the Behavioral Health section. While this issue is being resolved, we are voiding these cases manually and sending a message to providers why the case has been voided. Posted: …

We also added and updated corresponding preview questionnaires on the ereferrals.bcbsm.com website. New questionnaires. ... Gastric pacing / stimulation - This questionnaire now opens for BCN commercial members for procedure codes *43647, *43648, *43881, *43882, *64590 and *64595.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 …On Aug. 27, 2023, Blue Cross Blue Shield of Michigan and Blue Care Network will add and update questionnaires in the e- referral system. We'll also update the corresponding authorization criteria and preview questionnaires on the . ereferrals.bcbsm.com. website. As a reminder, we use our authorization criteria, our medical policies and your ...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.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 ...Blue Care Network commercial and BCN AdvantageSM April 2023 2 . What is Quartet? Quartet is an independent company contracted by Blue Cross Blue Shield of Michigan and Blue Care Network to help increase the speed with which fully insured adult members (18 and older) can access behavioral health services. Quartet can connect1 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 and BCN L ocal Rules for 2022 (non-behavioral health) Modifications of InterQual® acute care criteria For Blue Cross commercial, Medicare Plus BlueSM, Blue Care Network commercial and BCN AdvantageSM Effective March 1, 2022, through July 31, 2023 Published December 2021 / Updated July 2023 1 . In this document• 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 48226-2998To learn how to submit prior authorization requests for Blue Cross Blue Shield of Michigan and Blue Care Network members, visit the . ereferrals.bcbsm.com. website, click . Blue Cross or BCN, and then click Medical Benefit Drugs. Scroll down to find instructions for submitting prior authorization requests either through the NovoLogix ®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 theThis 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 medicineOnline Self-paced Learning Modules. We have developed interactive learning modules to help you learn core functionalities and features of the e-referral tool. Please click the title link in the table below to start each module. Module. Audience. BCN. Blue Cross. 1.• 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 ®ereferrals.bcbsm.com website and in our provider newsletters. For dates of service on or after April 1, 2021, we're designating certain medications as preferred products. This change will affect most Blue Cross Blue Shield of Michigan commercial, all Medicare Plus Blue. SM, all Blue Care Network commercial and all BCN Advantage. SM. members.Blue Cross and BCN quantity limits for medical drugs For Blue Cross commercial and BCN commercial **NOC Codes indicates the following: J3490, J3590, J9999, and C9399Even if you're not a member, you can answer a few questions to find the right network to search for doctors. In addition to staying in network, you or your doctor may need to get benefit approval or "prior authorization" before you get treatment for certain services for them to be covered. Please check your benefit booklet or your plan's ...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 theBCN 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 …Quick 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 ...For Blue Cross PPO (commercial) behavioral health requirements, see the For Blue Cross PPO (commercial) members section on ereferrals.bcbsm.com under Blue Cross then the Behavioral Health section. While this issue is being resolved, we are voiding these cases manually and sending a message to providers why the case has been voided. Posted: June ...Go to ereferrals.bcbsm.com. Click Blue Cross. Click Medical Benefit Drugs. Scroll to the Blue Cross commercial column. Review the information in the "How to submit authorization requests electronically using NovoLogix" section. More about the authorization requirements. Authorization isn't a guarantee of payment.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 Access this document via ereferrals.bcbsm.com to ensure you're viewing the most up-to-date information. Post-acute care For skilled nursing, rehabilitation and long-term acute care ... Blue Cross Blue Shield of Michigan and Blue Care Network members who have Medicare Advantage plans. Title: Post-acute care: For skilled nursing, rehabilitation ...For BCN: 1-844-377-1278 For services that do not have approved authorizations, claims may be denied and providers may not bill the member. Where to find additional information For information about finding clinical guidelines and submitting prior authorization requests, refer to these webpages on the ereferrals.bcbsm.com website :Important Information About Medicare Plans ©1996-2021 Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association.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.PAIN MANAGEMENT EPIDURAL STEROID INJECTIONS AUTHORIZATION REQUEST FORM Utilization management toll-free phone: 1-833-217-9670 Utilization management local phone: 313-908-6040ereferrals.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: • Memorial Day, Monday, May 29, 2023Musculoskeletal 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 …Yes, BCN will be loading some of the information contained on the previous e-referral system into the new system. Cases beginning Jan. 1, 2013 will be loaded into the new system. This includes cases spanning Jan. 1, 2013 - meaning cases that were authorized to start prior to Jan. 1, 2013 and extend beyond Jan. 1, 2013.providers please contact [email protected] or 800-437-3803 and ask for Kristy S. for further assistance) 2. After 10 days: Go to Ereferrals.bcbsm.com select Login (green button); you will be re-directed to Provider Secured Services. 3. On the Provider Secured Services screen look for the following link: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 CarelonApril 2023. Updated Experimental and investigational services questionnaire in the e-referral system starting May 1 (PDF) Starting June 1, submit prior authorization requests for ABA services through e-referral (PDF) Quartet Care Navigation Platform: FAQ for behavioral health providers is available (PDF) Updated questionnaires in the e-referral ...e-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.POSTSERVICE CHANGE REQUEST FORM Utilization management toll-free phone: 1-833-217-9670 Utilization management local phone: 313-908-6040 Utilization management fax: 313-879-5509Blue 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 MedicareApril 2023. Updated Experimental and investigational services questionnaire in the e-referral system starting May 1 (PDF) Starting June 1, submit prior authorization requests for ABA services through e-referral (PDF) Quartet Care Navigation Platform: FAQ for behavioral health providers is available (PDF) Updated questionnaires in the e-referral ...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.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.For BCN commercial and BCN Advantage members, you can find additional information about PT/OT/ST by therapists (for BCN commercial and BCN Advantage) and physical medicine services by chiropractors and athletic trainers (for BCN commercial) in the following resources: • BCN's Outpatient PT, OT, ST page of the ereferrals.bcbsm.com website.© 1996-Blue Cross Blue Shield of Michigan and Blue Care Network Nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association.Blue ...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.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: • Memorial Day, Monday, May 29, 2023Access 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 ...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 ...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. 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 ...To 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 BlueAccess 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 andBlue 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 ...is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to offer provider portal services. Confidentiality notice: This transmission contains confidential information belonging to the sender that is legally privileged. This information is intended only for use of the individual or entity named above.Vyvgart (efgartigimod alfa-fcab), HCPCS code J3590, will have prior authorization and site-of-care requirements for Blue Cross Blue Shield of Michigan and Blue Care Network group and individual commercial members starting Jan. 13, 2022. ... visit ereferrals.bcbsm.com and do the following: For Blue Cross commercial members: ...Advantages 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.Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association. The criteria for medications that need prior authorization or step therapy are based on current medical information and the recommendations of Blue Cross and BCN's Pharmacy— This document is a supplement to the BCN Referral / Clinical Review Program. — 2 BCN Clinical Review Medical Necessity Criteria / Benefit Review Requirements / UPD OCT 2016 Requested service Required clinical criteria and information Note: Refer to the BCN Referral / Clinical Review Program for referral and review requirements. Biofeedbackby 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 programBlue Care Network announces date for program changes for breast biopsy (excisional) BCN previously communicated in the Nov.-Dec BCN Provider News, clinical review will be required for breast biopsy (excisional) and CCTA for BCN commercial and BCN Advantage HMO-POS SM and BCN Advantage HMO SM members effective Jan. 1, 2014. The effective date of these changes will be Jan. 6, 2014.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 ...The following is a clarification of an earlier news item on this topic. Requirements for FCA and GM members only (employer groups 100181 and 100355). Effective with therapy that starts on or after Jan. 1, 2016: Authorization is required only for BCN commercial (non-Medicare) members with coverage through Fiat Chrysler Automobiles (employer ...Healthcare · U-M Premier Care Therapy Diagnosis Codes ICD-9 …ereferrals.bcbsm.com ...authorization for Blue Cross commercial, Medicare Plus Blue, BCN commercial and BCN Advantage members. For more information about TurningPoint's musculoskeletal surgical quality and safety management program, see the following pages on the . ereferrals.bcbsm.com. website: • Blue Cross Musculoskeletal Services • BCN Musculoskeletal Servicespage at bcbsm.com for details. Then: 1. Log in to availity.com*. 2. Click . Payer Spaces on the menu bar and click the BCBSM and BCN logo. 3. On the Applications tab, click the tile for the appropriate NovoLogix web tool. 4. Within NovoLogix, click the Authorizations menu and select Create Authorization. 5.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 Carelonreferral 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.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 ...e-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.for 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 managementClick 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. For BCN members: For DME and P&O, contact Northwood, Inc., at 1-800-393-6432. For diabetes supplies, contact J&B Medical Supply at 1-888-896-6233. For Blue Cross commercial members: For information about DME and diabetes supplies, contact Provider Inquiry at 1-800-249-5103 to determine benefits.providers please contact [email protected] or 800-437-3803 and ask for Kristy S. for further assistance) 2. After 10 days: Go to Ereferrals.bcbsm.com select Login (green button); you will be re-directed to Provider Secured Services. 3. On the Provider Secured Services screen look for the following link:Advantages 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.e-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.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 documentatione-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, 2018.15 E-referral www.ereferrals.bcbsm.com. Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the ...Enable Javascript support in the browser.October 2023. October 12, 2023: Changes to ereferrals.bcbsm.com (PDF) Updated: Blue Cross continues to pay claims during our union represented employee work stoppage at Blue Cross (PDF) Syfovre and Izervay must not be used with other geographic atrophy drugs for commercial members, starting Nov. 24 (PDF) Pombiliti, Rivfloza and Tofidence …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 [email protected]. bcbsm.com | ereferrals.bcbsm.com. Behavioral Health. Benefits and Eligibility. Care Management. Chronic Condition. Management. 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Find a Vision Provider. If your Blue Cross and Blue Shield of New Mexico (BCBSNM) plan includes vision coverage, select from the links below to search for a vision provider. BCBSNM Vision Plans *. Medicaid Plan (Blue Cross Community Centennial SM) **. Medicare Advantage Plans *.. Hyvee ad rochester mn

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Blue 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 40742For 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.Hospital NPIs (for Medical Referrals/ Authorizations) May 2019 Provider Name NPI Aleda E. Lutz VA Medical Center 1164471066 Allegan General Hospital 1295803377Blue Cross Blue Shield of Michigan implemented InterQual acute care, rehabilitation, long-term acute care and skilled nursing criteria effective Aug. 2, 2021. On this date, the modifications outlined below took effect and all previous modifications and InterQual criteria were replaced with these guidelines. All prior authorization requests must be22 Jun 2021 ... ... ereferrals.bcbsm.com/docs/common/common-bh-documentation-rqumts-aba.pdf. Carr, J. E., Wilder, D. A., Majdalany, L., Mathisen, D., & Strain, L ...eviCore-Managed Procedures. For Blue Cross commercial and Medicare Plus Blue members, providers must obtain authorization from eviCore healthcare ® for outpatient radiation oncology. Refer to the resources below for more information: Procedure codes that require authorization by eviCore healthcare (PDF) — List of procedure codes eviCore reviews.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 ...Electronic Commerce. Improve operational efficiency and turnaround time on claims by using electronic transactions for billing, payments, eligibility, and claim status.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.Blue Cross and BCN utilization management medical drug list for Blue Cross commercial and BCN commercial members. We'll update this list prior to the effective change of the change. You can access this list and other information about requesting prior authorization on the following pages of the ereferrals.bcbsm.com website:Training Tools. 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:Enable Javascript support in the browser.ereferrals.bcbsm.com website and in our provider newsletters. For dates of service on or after April 1, 2021, we're designating certain medications as preferred products. This change will affect most Blue Cross Blue Shield of Michigan commercial, all Medicare Plus Blue. SM, all Blue Care Network commercial and all BCN Advantage. SM. members.Blue Care Network announces date for program changes for breast biopsy (excisional) BCN previously communicated in the Nov.-Dec BCN Provider News, clinical review will be required for breast biopsy (excisional) and CCTA for BCN commercial and BCN Advantage HMO-POS SM and BCN Advantage HMO SM members effective Jan. 1, 2014. The effective date of these changes will be Jan. 6, 2014.• 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.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.Blue Cross Blue Shield of MichiganTo 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 ...Page i BCN Provider Manual (BCN commercial and BCN Advantage) Revised August 2023 . BCN Provider Manual - 2023 BCN commercial and BCN AdvantageSM. BCN Advantage . This chapter is subject to change. To ensure that you review the most current version, we ... bcbsm.com, ereferrals.bcbsm.com, MiBlueCrossComplete.com, mibluesperspectives.com ...Starting July 1, 2023, Blue Cross Blue Shield of Michigan and Blue Care Network will request that providers submit clinical outcomes using the Audaire Health provider portal following approval of prior authorization requests and administration of chimeric antigen receptor T-cell (CAR-T) therapy for Blue Cross and BCN commercial members.The following is a clarification of an earlier news item on this topic. Requirements for FCA and GM members only (employer groups 100181 and 100355). Effective with therapy that starts on or after Jan. 1, 2016: Authorization is required only for BCN commercial (non-Medicare) members with coverage through Fiat Chrysler Automobiles (employer ...codes that require authorization by TurningPoint” document on ereferrals.bcbsm.com. One authorization will cover both the setting and the procedure. The facility does not need to submit a separate authorization. The ordering physician should secure the required authorization and provide the authorization numbers to theU-M Premier Care Therapy Diagnosis Codes ICD-9 …ereferrals.bcbsm.com ...Access this document via ereferrals.bcbsm.com to ensure you're viewing the most up-to-date information. Post-acute care For skilled nursing, rehabilitation and long-term acute care ... Blue Cross Blue Shield of Michigan and Blue Care Network members who have Medicare Advantage plans. Title: Post-acute care: For skilled nursing, rehabilitation ...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.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.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. ereferrals.bcbsm.com BCN e‑referral Template Guide. Save time by creating templates for these referral types. For more information, see the Templates section in the . e-referral User Guide. located at . ereferrals.bcbsm.com. Outpatient Authorizations. Type of . service Authorization : type Service : to/from Number : of serviceereferrals.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:Online Self-paced Learning Modules. We have developed interactive learning modules to help you learn core functionalities and features of the e-referral tool. Please click the title link in the table below to start each module. Module. Audience. BCN. Blue Cross. 1. Accessing e-referral. 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.Prior authorization requirements. See the links within the accordions for information on prior authorization requirements for specific services. These lists aren't all-inclusive. You can learn more by clicking the relevant link in the Blue Cross or BCN section on our ereferrals.bcbsm.com website.Blue Cross/BCN. tool, and the change is not immediately reflected in ereferral, please check the following - day. How to find your Availity administrator . If you already have access to Availity: 1. Log in to Availity. 2. Click your name (in the top navigation) and click . My Account. 3. Click . Organization(s).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 medicineThis 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 medicineBlue Cross 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 request ... codes that require authorization by TurningPoint" document on ereferrals.bcbsm.com. One authorization will cover both the setting and the procedure. The facility does not need to submit a separate authorization. The ordering physician should secure the required authorization and provide the authorization numbers to theYes, BCN will be loading some of the information contained on the previous e-referral system into the new system. Cases beginning Jan. 1, 2013 will be loaded into the new system. This includes cases spanning Jan. 1, 2013 - meaning cases that were authorized to start prior to Jan. 1, 2013 and extend beyond Jan. 1, 2013.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.BCN commercial and BCN Advantage SM Revised June 13, 2023 4 . Availity ® is an independent company that contracts with Blue Cross Blue Shield of Michi gan and Blue Care Network to offer provider portal and electronic data interchange services. eviCore healthcare ® is an independent company that contracts with Blue Cross Blue Shield of MichiganTo 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 determine, before treating a patient, if Blue Cross Blue Shield of Michigan will cover the cost of a proposed service. Blue Cross requires prior authorization for services or procedures that may be experimental, may not always be medically necessary, or may be ... members job aid by going to ereferrals.bcbsm.com and clicking on the following ...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 …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 ...Per 15 min. • Modification to treatment protocol administered by the LBA. Must be done face to face with the client. • Each 15-minute increment of two or more technicians’ time face to face with the client requiresVyvgart (efgartigimod alfa-fcab), HCPCS code J3590, will have prior authorization and site-of-care requirements for Blue Cross Blue Shield of Michigan and Blue Care Network group and individual commercial members starting Jan. 13, 2022. ... visit ereferrals.bcbsm.com and do the following: For Blue Cross commercial members: ...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 Care Network website.. 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