Ereferrals.bcbsm.

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 ...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 ...By fax: Call the Pharmacy Clinical Help Desk at 1-800-437-3803 to obtain the pertinent medication request form, which you can then submit by fax. For Blue Cross' PPO members: Fax the medication request form to 1-866-601-4425. For BCN HMO members: Fax the medication request form to 1-877-442-3778. By written request: Mail a written request to:e-Referral - News Item. 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, effective Oct. 1, 2018.

JOINT AND SPINE PROCEDURES AUTHORIZATION REQUEST FORM Utilization management toll-free phone: 1-833-217-9670 Utilization management local phone: 313-908-6040From 7 a.m. on Saturday, Sept. 21 to 10 p.m. on Sunday, Sept. 22 (Eastern time) 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. You can get to this list anytime from any page of our ereferrals.bcbsm.com website.

July 2023. Update: Changes for in-lab sleep studies to start Oct. 9 (PDF) Updated questionnaires in the e-referral system (PDF) For commercial LTACH requests, submit information about three SNFs to avoid delays (PDF) Rystiggo ® and Vyvgart ® Hytrulo to require prior authorization for most commercial members (PDF)TurningPoint Provider Portal. Refer to BCN's Musculoskeletal Services page at ereferrals.bcbsm.com. • For dates of service prior to July 1, 2020, submit the request to BCN Utilization Management through the e-referral system and must complete the cervical spine surgery questionnaire that opens in the e-referral system.

Blue 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 ...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 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 ...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: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 service

For Blue Care Network commercial and BCN Advantage. SM. members . b. Perforator vein reflux of at least 500 milliseconds by duplex ultrasound AND planned saphenous reflux procedure 4. Leg or ankle edema or swelling with superficial vein reflux of at least 500 milliseconds by duplex ultrasound and findings continue after ALL of the following: a.

Blue Cross/BCN Provider Communications Created Date: 20221111145255Z ...

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 managementEnable Javascript support in the browser.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 ...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 ... 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 ...

ereferrals.bcbsm.com. They are dated May 2022. Blue Cross Blue Shield Blue Care Network @ of Michigan Nonprofit corporations and independent licensees ... Author: Blue Cross Blue Shield of Michigan and Blue Care Network Created Date: 5/24/2022 8:31:08 AM ...BCN commercial and BCN Advantage members. Blue Cross and BCN utilization management medical drug list for : Blue Cross commercial and BCN commercial Drugs marked “Oncology Management Program” are managed by Carelon (formerly AIM). If you think a code may require authorization but it isn’t listed, call Carelon at 1-844-377-1278 …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.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 ...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 onAdditional Resources. ▽. Blue Distinction Centers · News Archive · Quick Guides · bcbsm.com · BCN · Blue Cross. Home. Set up e-referral and Health e-Blue in ...BCN's Blue Elect Plus POS webpage on the . ereferrals.bcbsm.com website. For more details about Healthy Blue Choices POS, refer to BCN's Healthy Blue Choices POS webpage. Inpatient services Inpatient admissions: BCN Utilization Man agement must be notified of acute non-behavioral health inpatient

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 the• 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

When submitting requests before the effective date for the change. Prior to Feb. 17 or Feb. 24, 2022 (as applicable), fax your request for preservice review as follows: For Blue Cross commercial members: Fax to Provider Inquiry at 1-866-311-9603. For BCN commercial members: Fax to the Medical Drug Help Desk at 1 877 325 5979.Availity is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to offer provider portal services. naviHealth is an independent company that manages authorizations for post-acute care services for Blue Cross Blue Shield of Michigan and Blue Care Network members who have Medicare Advantage plans.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 ...ereferrals.bcbsm.com. They can also be accessed on the Quick Guides page located in the BCN Provider Publications and Resources website within. Provider ...identifying TIN and associated payee name (BCBSM/BCN does not accept W -9s) Anesthesia Assistant • New Allied Provider Enrollment Form -or- Allied Provider Change Form • BCBSM Anesthesia Assistant Combined Signature Document • Active Michigan practice location required • Type 1 National Provider Identifier • Social Security NumberBCN 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 ...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

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 ...

–Articles in BCN Provider News –Web-DENIS messages –One excellent place to go for information is ereferrals.bcbsm.com. Click Radiology Management. Note: ...

for both Medicare and Medicaid. These members are enrolled in either Original Medicare, BCN Advantage SM HMO-POS, BCN Advantage HMO ConnectedCare, BCN Advantage SM HMO MyChoice Wellness or BCBSM's Medicare Plus Blue PPO as their primary plan and Blue Cross Complete as their secondary plan.) Contact Blue Cross Complete to request clinical review: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*. 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.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 ...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 …Keyword Research: People who searched bcbsm holiday schedule 2023 also searchedBlue 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 documentationFor 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 48226-2998ereferrals.bcbsm.com. They can also be accessed on the Quick Guides page located in the BCN Provider Publications and Resources website within. Provider ...

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.for both Medicare and Medicaid. These members are enrolled in either Original Medicare, BCN Advantage SM HMO-POS, BCN Advantage HMO ConnectedCare, BCN Advantage SM HMO MyChoice Wellness or BCBSM's Medicare Plus Blue PPO as their primary plan and Blue Cross Complete as their secondary plan.) Contact Blue Cross Complete to request clinical review: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. e-Referral - News Item. 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, effective Oct. 1, 2018.Instagram:https://instagram. otc cvs login sunshine healthtarkov farming part 3nbc4 news anchorspublix super market at carillon town center 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. burlington hmartcomlex release dates Blue Cross Blue Shield of Michigan and Blue Care Network require health care providers to obtain approval before providing certain services. This approval is known as prior authorization and it helps to ensure that the services are appropriate for the patient’s condition and are medicallyHigh-tech radiology — This includes procedures for Michigan Blue Cross and Blue Shield Federal Employee Program ® members. In-lab sleep management — Blue Cross Commercial. Proton beam therapy. Echocardiogram services. Medical oncology - This applies to the following: Medicare Plus Blue members. usps package acceptance pending for 2 weeks 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 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