Additional Resources

Blue Cross Blue Shield of Michigan requires prior authorization for certain procedures to ensure that members get the right care at the right time and in the right location.

Health care providers must submit prior authorization requests before providing services. See the e-referral User Guide to learn how.

Authorization information for Blue Cross commercial and Medicare Plus Blue members

• Summary of utilization management programs for Michigan providers (PDF)
• Procedure codes for which providers must request prior authorization (PDF)
• Prior authorization requirements for Michigan and non-Michigan providers for Blue Cross commercial and Medicare Plus Blue SM (PDF)
• Criteria Request Form (for non-behavioral health cases) (PDF)
• Peer-to-peer reviews:
  • How to request a peer-to-peer review with a Blue Cross or BCN medical director (PDF)
  • Physician peer-to-peer-request form (for non-behavioral health cases) (PDF)

  Authorization information for Blue Cross commercial members

  • Federal Employee Program ® Consent for Case Management (PDF)
  • Prior authorization requirements for MESSA members (PDF)*

  Authorization information for Medicare Plus Blue members

  • Services That Require Authorization – Medicare Plus Blue PPO (PDF)
  • About Blue Dot changes to the list of Services That Require Authorization (PDF)
  • Authorization criteria and preview questionnaires (PDF) — For select services, links to authorization criteria for select services and preview questionnaires that show questions providers must answer in the e-referral system

  Utilization management forms

  You can find links to forms related to utilization management on our Provider Resources site. To access the forms:

  1. Log in to our provider portal (availity.com*).
  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).
  5. Click the Forms menu and make the appropriate selection.

  Documents and forms for noncontracted or non-Michigan providers

  • Prior authorization requirements for Michigan and non-Michigan providers for Blue Cross commercial and Medicare Plus Blue SM (PDF)
  • For Providers: What if I Don’t Participate with Medicare? page on bcbsm.com. This page provides access to the Waiver of Liability Statement, along with other pertinent documents and forms

  * 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 required to let you know we're not responsible for its content.

  Contact

  Frequently accessed documents

  • Care and utilization management programs: Overview for providers (PDF)
  • e-referral Quick Guide (PDF)
  • Provider resource guide at a glance (PDF)
  • Provider Manuals

  Additional resources

  • Blue Cross and BCN Provider Systems and Web Resources Guide (PDF)
  • Log in to our Provider Portal
  • bcbsm.com/providers
  • Find a doctor or hospital

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