Ereferrals.bcbsm
Blue Cross Blue Shield of Michigan P.O. Box 33248 Detroit, MI 48232-4248. Area codes: 734, 810, 947, 989 or outside Michigan. Provider Inquiry Blue Cross Blue Shield of Michigan P.O. Box 2227 Detroit, MI 48321-2227. Area codes: 231, 269, 616. Blue Cross Blue Shield of Michigan P.O. Box 230589 Grand Rapids, MI 49523-0589. Area code: 906 ... ©1996-2023 Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association. We provide health insurance in Michigan.
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ereferrals.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 . Submit an Inpatient Authorization . section. You can read more about this change on . Page 32 of the May-June 2023 . BCN Provider News.Blue Cross Blue Shield of Michigan and Blue Care Network offer care management programs and support services to members. These programs vary based on member coverage and may be administered by Blue Cross or BCN staff or by contracted vendors. Care management programs provide patient support by identifying patients with health risksOnline 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. 1.15 E-referral www.ereferrals.bcbsm.com. Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the ...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: ...SNFs must register for and learn the e-referral system before submitting commercial SNF authorization requests through e-referral starting Dec. 1. e-referral system out of service for maintenance overnight September 19-20. Avoid SNF claim denials for Medicare Advantage by matching PDPM levels on claims to the PDPM levels naviHealth authorized.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:medical benefit for BCN HMO and BCN Advantage members. Complete this form and fax it to BCN at 1-800-675-7278 along with supporting clinical documentation. Please contact BCN Care Management at 1-800-392-2512 with any questions. **Required for ALL requests** Drug information. ALL REQUESTED INFORMATION MUST BE PROVIDED FOR CONSIDERATION FOR ...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. 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 …Blue Cross and BCN utilization management medical drug list for Blue Cross . commercial and BCN commercial members . You can access this list and other information about requesting prior authorization on the following pages of the ereferrals.bcbsm.com website: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 ...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.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 ...Blue 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 Medicare• 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.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 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 …February 2021. Starting in May, additional medical benefit drugs will require prior authorization for some Blue Cross commercial members. Starting Feb. 28, a new questionnaire will open in the e-referral system for the pediatric feeding program for BCN commercial members.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 ... From 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.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 ...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.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 :
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 ...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.Watch for news on system updates, training and other topics at ereferrals.bcbsm.com. *Blue Cross Blue Shield of Michigan doesn’t own or control this website. Availity® 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. W010723For 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 :
• 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 48226-2998Blue 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.…
Reader Q&A - also see RECOMMENDED ARTICLES & FAQs. Prior authorization requirements. See the links within . Possible cause: To learn how to submit prior authorization requests for Blue Cross Blue Shield of Michi.
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.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 theBlue 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 the
Autism services : Billing guideline s and procedu re codes For Blue Cross commercial and Blue Care Network commercial Revised May 2023 . 1 . This document outlines activities, codes and rates for autism services, along with information about billing and documentation.- 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 autism
Below are links to documents detailing Blue Care Network's autho 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 ... medicine services for BCN members delivered by chiropraStarting Oct. 1, AIM Specialty Health ® to manage cardiology ereferrals.bcbsm.com. They can also be accessed on the Quick Guides page located in the BCN Provider Publications and Resources website within. Provider ...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. For BCN commercial members, fax to 1-866-601-4425. For BC Blue Cross/BCN Provider Communications Created Date: 20221027184301Z ... eReferrals [Holon]. Northern MI: 2016-. Public View everything Blue Cross Blue Shield of Michigan and Blue Cyou use BCN's e-referral system • If additional visits nee BCN 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 ... ereferrals.bcbsm.com. 4. What if I have tro 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. Blue Cross Blue Shield of Michigan and Blue[e-referral Provider Search feature — Within the e-reATTN: BCN Advantage Grievances and Appea 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).