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.18 sept 2018 ... ... ereferrals.bcbsm.com. Click Requirements for drugs covered under the medical benefit – BCN HMO under the heading "For BCN HMO (commercial) ...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.November 2022. Xenpozyme TM and Spevigo ® to have site-of-care requirements for most commercial members starting March 1 (PDF) New and updated questionnaires in the e-referral system starting Nov. 27 (PDF) Outpatient ECT won't require prior authorization for BCN members, starting Jan. 1 (PDF) Nov. 24-25 holiday closure: How to submit ...For drugs covered under the commercial Blue Cross or BCN medical benefit, please see the Blue Cross and BCN Utilization Management Medical Drug List. Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association. New coverage criteria for certain drugsCarelon Medical Benefits Management is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to manage authorizations for select services. For more information, go to our . ereferrals.bcbsm.com website.5 abr 2015 ... severity · scoring · healthcare · corresponds · ereferrals.bcbsm.com · ereferrals.bcbsm.com. You also want an ePaper? Increase the ...Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association. Clinical coding. You can access clinical coding specific to the procedures included in the program in the . Musculoskeletal procedure codes that require authorization by TurningPoint document.- For Blue Cross and BCN members in groups subject to the mandate, benefits went into effect Oct. 15, 2012. - The Oct. 15, 2012, effective date did not apply to all groups. Blue Cross and BCN groups not subject to the mandate have the option to offer the mandated autism benefit. • Find more information about the autismThis 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 medicineFor 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.BCN Provider Resource Guide - e-Referral - Home. BCN Provider Resource Guide Behavioral Health Welcome to the BCN Provider Resource Guide!Benefits and Eligibility In this Guide you will find contact information for many of the services that BCN offers Care Management and for the functions you most frequently perform in servicing BCN members. Chronic Condition Use the navigation bar at the left ...1 day ago · See how Blue Cross can. help you stay covered. Learn more. Find a doctor, dentist, hospital or other provider in your area using our find a doctor search.• BCN Utilization Management department • eviCore healthcare® Keep reading to learn which members have access to or requirements under these programs. Programs may not apply to all members. This document is subject to change. Access this document via ereferrals.bcbsm.com to ensure you're viewing the most up-to-date information.Register. Create a delegate or prescriber account to start processing prior authorizations today. Register. Surescripts does not store or maintain information of portal transactions for, or on behalf of, any end user. End users must retain a copy of each transaction for their record keeping purposes. End users located outside the United States ...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.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)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 CarelonNovember 2022. Xenpozyme TM and Spevigo ® to have site-of-care requirements for most commercial members starting March 1 (PDF) New and updated questionnaires in the e-referral system starting Nov. 27 (PDF) Outpatient ECT won't require prior authorization for BCN members, starting Jan. 1 (PDF) Nov. 24-25 holiday closure: How to submit ...Trogarzo TM and Zilretta ® require authorization for commercial members starting Oct. 1. For dates of service on or after Oct. 1, 2018, Trogarzo and Zilretta will be added to the medical drug prior authorization program for Blue Cross PPO (commercial) and BCN HMO SM (commercial) members.. Trogarzo will also be subject to a site-of-care requirement for BCN HMO (commercial) members only ...Access this document via ereferrals.bcbsm.com to ensure you're viewing the most up-to-date information. Durable medical equipment and ... diabetes supplies (except shoes and inserts) for Blue Cross Blue Shield of Michigan and Blue Care Network members who have Northwood Inc. is an independent company that manages bothereferrals.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 . …Access this document via ereferrals.bcbsm.com to ensure you're viewing the most up-to-date information. Outpatient PT, OT and ST, and physical medicine ... eviCore healthcare is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to manage authorizations for select services. For more information ...To access the list of Services That Require Authorization, visit ereferrals.bcbsm.com and click Blue Cross. Then click Authorization Requirements & Criteria on the left navigation bar. December 2017 . Blue Dot changes to the Blue Cross Medicare Plus Blue Service / Topic Vanousereferrals.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: • Floating Independence Day, Monday, July 3, 2023Blue 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.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 ...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 48226-2998e-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 …Board-certified behavior analyst town hall presentation - e-ReferralAuthorization Requirements & Criteria page at ereferrals.bcbsm.com. Acute and Post-acute care facilities — Non-Michigan (without access to Availity) (Acute Inpatient …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 ...benefit for Blue Cross Blue Shield of Michigan and Blue Care Network commercial members. Michigan prescribers . To submit prior authorization requests electronically, first register for Availity ® Essentials, our provider portal; refer to the . Register for web tools. page at bcbsm.com for details. Then: 1. Log in to availity.com*. 2. Click ...Lines of business: Blue Cross Blue Shield of Michigan and Blue Care Network ...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.Care management and utilization management programs Overview for providers Revised September 2023 Services available for these products (may not apply to all groups or individual members): Blue Cross commercial Medicare Plus Blue BCN commercial BCN Advantage Blue Cross Blue Shield of Michigan and Blue Care Network offer the following programs to members.Blue Care Network commercial and BCN AdvantageSM Revised January 2022 To request the criteria used in making a determination on a specific authorization request : 1. Complete every field below. 2. Fax the completed form to 1 -866 373 9468. This applies only to non-behavioral health authorization requests for which the Blue Cross and BCNHigh-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.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 ...Blue Cross Blue Shield of MichiganAuthorization Requirements & Criteria page at ereferrals.bcbsm.com. Acute and Post-acute care facilities — Non-Michigan (without access to Availity) (Acute Inpatient …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 Access this document via ereferrals.bcbsm.com to ensure you're viewing the most up-to-date information. Durable medical equipment and ... diabetes supplies (except shoes and inserts) for Blue Cross Blue Shield of Michigan and Blue Care Network members who have Northwood Inc. is an independent company that manages bothSeptember 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)Go to ereferrals.bcbsm.com. 2. Click . Blue Cross. Provider alert . Blue Cross commercial Category: Pharmacy . Publication start date: Dec. 10, 2021 Publication end date: March 31, 2022 . 4 . 3. Click Medical Benefit Drugs . 4. Scroll to the Blue Cross commercial column. 5. Review the information in the "How to submit authorization requests ...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.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 ... bcbsm.com, ereferrals.bcbsm.com, MiBlueCrossComplete.com, mibluesperspectives.com, ahealthiermichigan.org and valuepartnerships.com. Blue Cross, Blue Care Network and Blue Cross Complete do not control any other websites referenced in . this publication or endorse their general content.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.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.Time is running out to give us your opinion on provider training. You have until July 31 to complete our online survey. Your response will help us improve the way we distribute information to you. Thank you for your time and your input. Posted: July 2018. Lines of business: Blue Cross Blue Shield of Michigan and Blue Care Network.• 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 ®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 medicineTo 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.Blue Cross/BCN Provider Communications Created Date: 20221111145255Z ... — 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. BiofeedbackBlue 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 documentTraining 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:You can access this document from the ereferrals.bcbsm.com website, on these webpages: Blue Cross Authorization Requirements & Criteria page. BCN Authorization Requirements & Criteria page. Here are the additional upcoming closures that will occur during 2021, so you can plan ahead: Good Friday - Friday, April 2. Memorial Day - Monday, May 31.BCN Healthy Blue Choices POS. Healthy Blue Choices POS. Healthy Blue Choices SM POS is a point-of-service product for FCA non-bargaining employees and retirees that is administered by Blue Care Network. Healthy Blue Choices POS allows the flexibility to receive covered health care services in or out of network without a referral.Use the BCN Provider Resource Guide to locate the BCN help you need. Go to ereferrals.bcbsm.com and click on Quick Guides. Keep these phone numbers handy: • For coverage, claims or primary care physician assignment, call BCN Provider Inquiry: 1-800-344-8525 • For technical support with BCN systems, call the Web Support Help Desk: 1-877-258-3932benefit for Blue Cross Blue Shield of Michigan and Blue Care Network commercial members. Michigan prescribers . To submit prior authorization requests electronically, first register for Availity ® Essentials, our provider portal; refer to the . Register for web tools. page at bcbsm.com for details. Then: 1. Log in to availity.com*. 2. Click ...Hospital NPIs (for Medical Referrals/ Authorizations) May 2019 Provider Name NPI Aleda E. Lutz VA Medical Center 1164471066 Allegan General Hospital 1295803377We're adding prior authorization requirements for Blue Cross Blue Shield of Michigan and Blue Care Network group and individual commercial members for the following drugs covered under the medical benefit: ... To learn how to submit requests through NovoLogix, visit ereferrals.bcbsm.com and do the following: For Blue Cross commercial members: ...©1996-Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association.We provide health insurance in Michigan.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 ... 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.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 …We would like to show you a description here but the site won't allow us.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.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.©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.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.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 ...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.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• Facilities interested in applying as a BCN-approved autism evaluation center (AAEC) should submit a letter of intent. Providers whose letters of intent are accepted will be asked to complete a formal application. Additional information is available on BCN’s Autism page at . ereferrals.bcbsm.com > BCN > Autism.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 48226-2998 Primary. care. physician. Abdullah, Ashraf. Ahmad, Babar. Babu, Anusuya. Colon, Frances. Feldpausch, Dale. Harker, Leanne E. (Nurse. Practitioner) Specialty. Internal ...Nov 9, 2022 · 2. Click Payer Spaces on the menu bar and then click the BCBSM and BCN logo. 3. Click the Resources tab. 4. Click Secure Provider Resources (Blue Cross and BCN). Information for out-of-state providers See the following documents for referral and authorization requirements. • For Blue Cross commercial and Medicare Plus Blue members:12 jul 2015 ... ereferrals.bcbsm.com. You also want an ePaper? Increase the reach of your titles. YUMPU automatically turns print PDFs ...Musculoskeletal Services. Providers must obtain authorization from TurningPoint Healthcare Solutions LLC for: Orthopedic procedures. Pain management procedures. Spinal procedures. This requirement applies to BCN commercial and BCN Advantage SM members. For information about musculoskeletal services for Blue Cross commercial and Medicare Plus ... BCN commercial and BCN AdvantageSM requests. January 2021 . 1. , Access this document via ereferrals.bcbsm.com to ensure you're viewing the , • BCN Medical-Benefit Drugs If you need help with the NovoLogix tool, contact the Web Support Help De, ereferrals.bcbsm.com. Chemical peels Authorization is required for all members. You must complete the der, Watch for news on system updates, training and other topics at ereferrals.bcbsm, Go to ereferrals.bcbsm.com. 2. Click . Blue Cross. Provider alert . Blue Cross commercial Category: Pharmacy ., Blue Cross Blue Shield of Michigan bcbsm.com 600 E. Lafayette B, For information on how to submit requests and for ot, by calling 1-844-377-1278 (BCN) or 1-800-728-8008 (Blue Cro, Oct 5, 2023 · TurningPoint reviews this procedur, BCN Provider Inquiry Contact Information (PDF) - Provider Inquiry, Nov 22, 2022 · POSTSERVICE CHANGE REQUES, Go to ereferrals.bcbsm.com. 2. Click . Blue Cross. 3. Cli, BCBSM Clinical Help Desk P.O. Box 312320 Detroit, MI 48231-2320, Blue Cross/BCN Provider Communications Created Date: 20221, For BCN commercial members, fax to 1-866-601-4425. For BCN Advant, Additional updated authorization criteria and e-referral qu, Procedure codes for which providers must request prior autho.