Non-Michigan providers. Non-Michigan providers who treat Medicare Advantage members who travel or live outside of Michigan should review the following documents: For Medicare Plus Blue members: Medicare Plus Blue PPO Fact Sheet (PDF) For BCN Advantage members: Non-Michigan providers: BCN referral and authorization requirements (PDF) 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. Accessing e-referral.For 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 :BCN Advantage members • Blue Cross and BCN utilization management medical drug list for Blue Cross commercial and BCN commercial members We'll update these lists prior to the effective dates of the change. You can access these lists and other information about requesting prior authorization at : ereferrals.bcbsm.com, at these locations:Blue Cross Blue Shield of MichiganBehavioral 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 practitionersCarelon-Managed Procedures (formerly AIM) Providers must obtain prior authorization from Carelon Medical Benefits Management (formerly known as AIM Specialty Health ®) for: In-lab sleep studies for BCN commercial members — For dates of service on or after Sept. 1, 2023. Select cardiology and radiology services for BCN commercial and BCN ...Ban lãnh đạo Bệnh viện. ĐIỆN THOẠI: (84-258) 3854 213. HOTLINE NGÀNH Y TẾ: 1900-9095. EMAIL: [email protected]. HOTLINE BỆNH VIỆN. 0965 311 515.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.Blue Cross Blue Shield of Michigan and Blue Care Network offer care management programs and support services to members. We also 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.Elect Plus POS, refer to BCN's Blue Elect Plus POS webpage on the ereferrals.bcbsm.com website. Blue Elect Plus POS is available Jan. 1, 2021. Note: As a rule, physicians must follow the authorization requirements that apply to the region in which the headquarters for their medical care group is located.Blue Cross Blue Shield of Michigan and Blue Care Network offer care management programs and support services to members. We also 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.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 MichiganBCN Care Management provider call volumes high. BCN Care Management is experiencing high call volumes. To avoid waiting on the phone line, providers should use BCN's e-referral system to submit or check the status of referrals or requests for clinical review.We encourage providers to call the Medical Information Specialist line at 1-800-392-2512 with urgent requests only.BCN commercial : BCN Advantage . During business hours: Call 1-800-392-2512. After business hours: Call 1-800-851-3904. Post-acute admissions and concurrent reviews : UAW Retiree Medical Benefits Trust Blue Cross non-Medicare . Fax to 1-866-915-9811. Note: Faxes received after business hours will be processed the next business day. Other Blue Crossyou use BCN's e-referral system • If additional visits needed, practitioner completes the revised Outpatient Treatment Authorization form • Visits are authorized based upon: - the number of sessions requested - progress being made toward established goals - use of evidence-based treatment - an appropriate projected therapy end dateBCN commercial : Fax to 1-866-534-9994 anytime. Behavioral health services : Medicare Plus Blue . Call 1-888-803-4960 anytime. BCN commercial . Call 1-800-482-5982 anytime, for services managed by BCN. BCN Advantage . Call 1-800-431-1059 anytime. Monthly e-referral maintenance (outage) schedulee-Referral - News Item. For dates of service on or after Oct. 1, 2018, AIM Specialty Health will manage the authorization process for cardiology and high-tech radiology procedures for BCN HMO SM (commercial) and BCN Advantage SM members. We first communicated about this in the article AIM Specialty Health to manage cardiology and high-tech ...For Blue Care Network commercial and BCN AdvantageSM Effective Aug. 27, 2023 . 1 . Responsive neurostimulator/deep brain stimulation trigger We provide coveragefor this procedure for pediatric and adultmembers who meet medical necessity criteria. Submit authorization requests through the e-referral system.Chateau Benátky nad Jizerou (Zámek Benátky nad Jizerou) is situated on a prominent promontory above the right bank of the Jizera River, where it forms a dominant feature visible from far away.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.Blue Care Network commercial and BCN AdvantageSM April 2023 2 . What is Quartet? 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. Quartet can connect 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.Blue Cross/BCN Provider Communications Created Date: 20221028193448Z ...To ensure continued access for current e-referral users. You must login at least once every 90 days to keep you user ID active. If your user ID is not working, please contact Availity ® Client Services at 1-800-AVAILITY (1-800-282-4548).. To sign up as a new e-referral userCarelon 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. *Clicking this link means that you're leaving the Blue Cross Blue Shield of Michigan and Blue CareUpdated Medicare local coverage determination for facet joint injections for Medicare Plus Blue SM and BCN Advantage SM members, starting April 25, 2021. For dates of service on or after April 25, 2021, the updated Medicare local coverage determination for facet joint interventions for pain management (L38841) applies.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 Carelon-Managed Procedures (formerly AIM) Providers must obtain prior authorization from Carelon Medical Benefits Management (formerly known as AIM Specialty Health ®) for: In-lab sleep studies for BCN commercial members — For dates of service on or after Sept. 1, 2023. Select cardiology and radiology services for BCN commercial and BCN ...PAIN MANAGEMENT EPIDURAL STEROID INJECTIONS AUTHORIZATION REQUEST FORM Utilization management toll-free phone: 1-833-217-9670 Utilization management local phone: 313-908-6040Jul 20, 2023 · 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 facilities, and for nonclinical, transitional care July 2023 :and BCN Advantage. SM. members. For more information about the criteria TurningPoint uses to make determinations on authorization requests for pain management procedures for all members , see this . news item on the ereferrals.bcbsm.com website. Frequency of sessions allowed for epidural steroid injections . Previous policy Updated policyBlue Care Network commercial and BCN AdvantageSM April 2023 2 . What is Quartet? 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. Quartet can connect Aug 30, 2023 · ereferrals.bcbsm.com. Note: The information in these tables is for summary purposes only. For Blue Cross commercial members, not all services in the categories listed require authorization for every employer group. The lists of groups identified as excluded from specific authorization requirements are not all-Below are links to documents detailing Blue Care Network's authorization and referral requirements for services managed by BCN, including lists of procedures that require authorization and authorization criteria and preview questionnaires for various procedures. These apply to services other than drugs covered under the medical benefit. 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. 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 to inquire.Ban lãnh đạo Bệnh viện. ĐIỆN THOẠI: (84-258) 3854 213. HOTLINE NGÀNH Y TẾ: 1900-9095. EMAIL: [email protected]. HOTLINE BỆNH VIỆN. 0965 311 515.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 applicable BCN commercial and BCN Advantage Not applicable Can the provider bill under supervision? Yes . Note: If billing under a fully licensed psychologist or under a physician (MD/DO), the supervising provider's NPI must be used and the appropriate modifier (HO or AJ) is required. No Yes, but the provider must be in an OPC and: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 MichiganEnable Javascript support in the browser.For BCN commercial, call 1-800-482-5982. For BCN Advantage, call 1-800-431-1059. Additional information. As a reminder, you can access resources related to authorizations and referrals on our ereferrals.bcbsm.com website. Click either Blue Cross or BCN and then use the links in the left navigation to reach information related to specific services.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 risksClick 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.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.• 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.Below are links to documents detailing Blue Care Network's authorization and referral requirements for services managed by BCN, including lists of procedures that require authorization and authorization criteria and preview questionnaires for various procedures. These apply to services other than drugs covered under the medical benefit.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 ...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.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 CarelonWe would like to show you a description here but the site won't allow us.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:. User guides and documentationBlue Care Network commercial and BCN AdvantageSM April 2023 2 . What is Quartet? 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. Quartet can connect BCN Advantage SM. BCN 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 …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.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 risksTo 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 Blue Shield of Michigan and Blue Care Network offer care management programs and support services to members. We also 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.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.Drugs (bcbsm.com) document for additional details . PPO . HMO . Preferred product information . J7665 Aridol Capsule Mannitol J1944/J1943 . Aristada . aripiprazole lauroxil J1652 Arixtra, Fondaparinux Fondaparinux Sodium J9261 Arranon, Nelarabine Nelarabine J9017 Arsenic, Trisenox Arsenic Trioxide ...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 [email protected] during the normal business hours of 8 a.m. to 5 p.m. (except for weekends and holidays). he peerT -to-peer review request must be submitted within seven business days of the date the initial prior authorization request was denied. Outreach will not occur until the next business day. The peer-to-peer review willChanges to ereferrals.bcbsm.com Blue Cross commercial, Medicare Plus BlueSM, BCN commercial and BCN AdvantageSM Date posted: October. 12, 2023 1 …TurningPoint Healthcare Solutions LLC is an independent company that manages authorizations for musculoskeletal surgical and related procedures for Blue Cross Blue Shield of Michigan and Blue Care Network. For more information, see the Musculoskeletal Services pages on our ereferrals.bcbsm.com website.ereferrals.bcbsm.com. website. *For self-funded plans, the employer assumes the risk for claims costs and pays a fee for administrative services provided by Blue Cross or BCN. **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,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.Oct 10, 2023 · Authorization Requirements & Criteria page at ereferrals.bcbsm.com. Acute and Post-acute care facilities — Non-Michigan (without access to Availity) (Acute Inpatient Hospital, Inpatient Rehab, Skilled Nursing, Long Term Acute Care Hospitals) Blue Cross Precertification Services are available 24 hours per day, 7 days a week to receiveSeptember 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 and Blue Care Network provide utilization management programs. ... Access this document via ereferrals.bcbsm.com to ensure you're viewing the most up-to-date information. Musculoskeletal services For joint and spine care Revised August 2023 :Aug 30, 2023 · ereferrals.bcbsm.com. Note: The information in these tables is for summary purposes only. For Blue Cross commercial members, not all services in the categories listed require authorization for every employer group. The lists of groups identified as excluded from specific authorization requirements are not all-Our provider manuals offer utilization management information that can be helpful to you and are updated regularly. BCN Provider Manual. In the BCN Provider Manual, you’ll find information about prior authorization and referral requirements that apply to BCN commercial and BCN Advantage members in these chapters: 30 sept 2023 ... Ereferrals.bcbsm · Busted newspaper kershaw county · Who is your my hero academia boyfriend · Izuku gets momo pregnant fanfiction · How much ...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.Xgeva ® to require authorization for BCN Advantage SM members. Xgeva (J0897) will continue to require authorization for BCN Advantage members in 2019. On Nov. 1, 2018, a web-DENIS message and a news item at ereferrals.bcbsm.com were posted indicating that Xgeva would not require authorization starting Jan. 1, 2019, for BCN Advantage members.. However, you'll need to continue to submit ...18 sept 2018 ... ... ereferrals.bcbsm.com. Click Requirements for drugs covered under the medical benefit – BCN HMO under the heading "For BCN HMO (commercial) ...ereferrals.bcbsm.com website. Scroll down the left navigation pane and look for the blue tile at the bottom. We're providing this information so you can plan ahead. We apologize for any inconvenience you may experience while the e-referral system is down. .ereferrals.bcbsm.com. Chemical peels Authorization is required for all members. You must complete the dermal chemical peel questionnaire or epidermal chemical peel questionnaire that opens in the e-referral system. For more information, refer to the BCN-managed procedure codes that require authorization document.Through BCN's web-DENIS system, you can submit claims electronically and access various provider resources, such as the BCN Provider Manual. Through BCN's e-referral system, you request authorization for certain types of behavioral health care ... ereferrals.bcbsm.com and click Sign Up or Change a User. The e-referral system requires a ...Mar 23, 2023 · 1. No history of ablation and ALL of the following: a. Must have one of the following symptoms: i. Presyncope or syncope by history ii. Palpitationsereferrals.bcbsm.com. Create successful ePaper yourself. Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software. START NOW . Occupational Therapy Treatment Authorization Guide. Introduction. The information contained in this guide serves as an orientation and reference guide to ...Carelon-Managed Procedures (formerly AIM) Providers must obtain prior authorization from Carelon Medical Benefits Management (formerly known as AIM Specialty Health ®) for: In-lab sleep studies for BCN commercial members — For dates of service on or after Sept. 1, 2023. Select cardiology and radiology services for BCN commercial and BCN ...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:. User guides and documentationBelow are links to documents detailing Blue Care Network's authorization and referral requirements for services managed by BCN, including lists of procedures that require authorization and authorization criteria and preview questionnaires for various procedures. These apply to services other than drugs covered under the medical benefit.ereferrals.bcbsm.com. website: • Blue Cross Medical Benefit Drugs • BCN Medical Benefit Drugs . Carelon Medical Benefits Management (formerly AIM Specialty Health ) is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to manage authorizations forBlue Cross Blue Shield of MichiganSeptember 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)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:Blue Cross and BCN acute care inpatient admissions. 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.To learn how to submit prior authorization requests for Blue Cross Blue Shield of Michigan and Blue Care Network members, visit the . ereferrals.bcbsm.com. website, click . Blue Cross or BCN, and then click Medical Benefit Drugs. Scroll down to find instructions for submitting prior authorization requests either through the NovoLogix ®Blue Cross Blue Shield of Michigan and Blue Care Network offer care management, Blue Cross Blue Shield of Michigan commercial March 2023 2 . Settings or scenarios . Prior authorizatio, October 2023. October 12, 2023: Changes to ereferrals.bcbsm.com (PDF) Updated: Blue Cross continues to pay claims d, and BCN Advantage. SM. members. • See also the 2022 Blue Cross and BC, April 2023. Updated Experimental and investigational services questionnaire in the e-referral system starting May 1, BCN commercial : BCN Advantage . During business hours: C, case pends and BCN cannot authorize it, BCN will contact the provider for additional clinical information. Proced, providers please contact [email protected] or 800-437-3803 and a, e-referral Provider Search feature — Within the e-referra, webpage at ereferrals.bcbsm.com Note: If any of the infor, Go to ereferrals.bcbsm.com. 2. Click on Sign Up or Cha, Quick Guides. e-referral Quick Guide ( PDF) - A brief overvi, September 2023. Changes to preferred drug designations under t, For Blue Cross PPO (commercial) behavioral health requir, Carelon Medical Benefits Management is an independent c, Blue Cross Blue Shield of Michigan and Blue Care Network offer, Save time and submit your prior authorization requests ..., Blue Cross and BCN utilization management medical drug list f.