Ereferrals.bcbsm.

Blue Cross Blue Shield of Michigan bcbsm.com 600 E. Lafayette Blvd., Detroit, MI 48226-2998 A nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association Customer Service: 800-XXX-XXXX To locate participating providers outside of Michigan: 800-810-2583 Misuse may result in prosecution.managed by BCN Care Management (not by BCN Behavioral Health or by BCN's physical, occupational and speech therapy vendor, Landmark HealthCare). Call BCN Care Management at 1-800-392-2512. • Nutritional counseling for autism spectrum disorders does not require authorization but must be performed by an in-network BCN practitioner.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 ...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.

Blue Cross/BCN Provider Communications Created Date: 20221027184301Z ...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.For Blue Care Network commercial and BCN AdvantageSM Effective April 24, 2022 . 1 . Endoscopy, upper gastrointestinal, for Gastroesophageal Reflux Disease (GERD) We provide coveragefor this procedure for adult members who meet medical necessity criteria. Submit authorization requests through the e-referral system.

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.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 or

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 questionnaires in the e-referral system, starting May 14 (PDF) Updated medical record documentation guidelines for musculoskeletal procedures (PDF) Register now for training on how ... In September 2020, Blue Cross Blue Shield of Michigan and Blue Care Network announced in . The Record. and in . BCN Provider News. that we're moving to the Availity ® provider portal. The transition began March 19, 2022, as shown in the diagram below. This document contains frequently asked questions about this transition. General informationBlue Cross and BCN quantity limits for medical drugs. For information on additional drugs that require prior authorization for UAW Retiree Medical Benefits Trust members with Blue Cross non-Medicare plans, see the . Medical oncology prior authorization list for UAW Retiree Medical Benefits Trust PPO non-Medicare members.Blue Cross Blue Shield of Michigan

For Blue Care Network commercial and BCN AdvantageSM Effective April 24, 2022 . 1 . Endoscopy, upper gastrointestinal, for Gastroesophageal Reflux Disease (GERD) We provide coveragefor this procedure for adult members who meet medical necessity criteria. Submit authorization requests through the e-referral system.

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 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 documentBlue 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 ...For 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)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.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, …

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. commercial and BCN Advantage members through Dec. 31, 2020. For dates of service on or after Jan. 1, 2021, these services are managed by TurningPoint Healthcare Solutions LLC; refer to BCN's Musculoskeletal Services. page of our ereferrals.bcbsm.com website for more information.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 ...Blue Cross Blue Shield of MichiganIn 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 ...— 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. Biofeedback

ereferrals.bcbsm.com or on our Provider Resources site under Member Care > Behavioral ... 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. ...

Starting May 18, 2023, we're adding a prior authorization requirement for most Blue Cross Blue Shield of Michigan and Blue Care Network group and individual commercial members for the following drug covered under the medical benefit: • Qalsody (tofersen), HCPCS code J3590 ... ereferrals.bcbsm.com website: • Blue Cross Medical Benefit Drugs .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 onto 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 ...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: • Good Friday, Friday, April 7, 2023Access 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 ...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: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 48226-2998Blue 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 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. Biofeedback

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.

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 ...

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 ...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.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 MichiganCall 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 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 theAdditional 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.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)Blue Cross Blue Shield of Michigan Medicare Advantage Grievances and Appeals Department P.O. Box 2627 Detroit, MI 48231-2627 ... ereferrals.bcbsm.com : website: • Blue Cross Carelon-Managed Procedures • BCN Carelon-Managed Procedures You’ll also find information in the document titled :A Blue Cross-approved autism 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 New Directions at 1-877-563-9347. The treatment plan prepared by the AAEC must include a recommendation ...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 or Go to ereferrals.bcbsm.com. 2. Click on Sign Up or Change a User. Health e-Blue ... Network patient data and Blue Cross Blue Shield of Michigan Medicare Advantage patient data (Health e-Blue application) For technical help with BCN systems, call the Web Support Help Desk at 1-877-258-3932.

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 andAccess 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 ...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.Instagram:https://instagram. maine state lottery pick 4 previous winning numberspua login massachusettspredator 3500 generator parts diagramcraigslist free philadelphia pa 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. kare radarcarter go kart for sale 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 …POSTSERVICE CHANGE REQUEST FORM Utilization management toll-free phone: 1-833-217-9670 Utilization management local phone: 313-908-6040 Utilization management fax: 313-879-5509 paychex flex online login April 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 ... BCN commercial and BCN AdvantageSM Revised June 2023 1 . This document provides contact information for Blue Cross Blue Shield of Michigan and Blue Care Network departments and contracted vendors. Use these links to go directly to a section within this document: • Blue Cross commercial provider resources • Medicare Plus Blue provider resourcesAccess this document via ereferrals.bcbsm.com to ensure you're viewing the most up-to-date information. Elective procedures and services ... management services for Blue Cross Blue Shield of Michigan and Blue Care Network members who have commercial plans. *For self-funded plans, the employer assumes the risk for claims costs and ...