Bcbs of michigan provider phone number for prior authorization


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    1. Bcbs of michigan provider phone number for prior authorization. If providers don’t obtain prior authorization for home health care services from CareCentrix, claims may be denied. Prior Authorization Automation. TTY users: To reach any number listed here, dial 711. 8 (PDF) Changes to the BCN referral and authorization requirements for Michigan providers Contracted with Blue Cross Blue Shield of Michigan or Blue Care Network? Steps; Michigan: Yes: Michigan’s prior authorization law* requires health care providers to submit prior authorization requests electronically. A few plans may continue to require prior authorization for behavioral health services to include applied behavioral analysis (ABA) therapy. How do I submit prior authorization requests to TurningPoint? Submit prior authorization requests to TurningPoint as follows: • For commercial members, Michigan’s prior authorization law** requires health care providers to submit prior authorization requests electronically. Alternate submission methods are allowed in the case of temporary technological problems, such as power or internet outages; see the information about submitting prior authorization requests Availity ® Essentials is Blue Cross Blue Shield of Michigan and Blue Care Network’s provider portal. prior authorization law requirements * go into effect on June 1, 2023. Require prior authorization requirements to be based on peer-reviewed clinical review criteria. If you have questions about Prior Authorization. Blue Shield Medicare. Non-formulary exception and quantity limit exception (PDF, 129 KB) Prior authorization/coverage determination form (PDF, 136 KB) Prior authorization generic fax form (PDF, 201 KB) Prior authorization urgent expedited fax form (PDF, 126 KB) ©1996-2024 Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross Blue Shield Association. We offer provider training. We're here to answer your questions about your benefits, services and medical needs. Frequently asked questions for providers . com; 1-800-327-0641; Please note: We strongly recommend using RadMD to request a prior authorization. Determining prior authorization requirements for members For Michigan and non -Michigan providers Revised July 3, 2024 1 . Information on participating network providers at home and while traveling 1-800-810-2583. ©1996-2024 Blue Cross Blue Shield of Michigan and Blue Care Network are How to submit prior authorization requests *Clicking this link means that you’re leaving the Blue Cross Blue Shield of Michigan and Blue Care Network website. Phone . - 4:30 p. Prior authorization list. Hospitals or facilities: 1-800-249-5103. Inpatient admissions (scheduled and/or nonemergent), certain outpatient services, emergent admissions/obstetric (request authorization within two (2) business days of the admission), requests for extensions Blue Cross Complete of Michigan; Blue Shield of California; BlueChoice HealthPlan; The documents below have been designed to help RadMD users navigate the prior authorization process for each program Evolent (formerly National Imaging Associates, Inc. Revised February 2024 . 7 days a week — participating and non-participating providers can: Submit prior authorization requests Prior authorization lookup tool for Anthem Blue Cross and Blue Shield providers Follow these steps to submit prior authorization requests when prescribing drugs covered under the medical benefit for Blue Cross Blue Shield of Michigan and Blue Care Network commercial members. Blue Cross and Blue Shield of Texas 1800 West Loop South, Suite 600 Houston, TX 77027-3279 800-637-0171, press 3 1-713-663 How to submit prior authorization requests *Clicking this link means that you’re leaving the Blue Cross Blue Shield of Michigan and Blue Care Network website. FEP Blue Focus You must obtain prior approval for these services in all outpatient and inpatient settings unless otherwise noted. For more information, see the document titled . Submit A New Prior Authorization; Find Contact Information; Podcasts; Misc. Blue Cross Blue Shield of Michigan uses the NovoLogix ® tool to manage prior authorization requests for medical benefit drugs. Contact Name Contact Telephone Number Contact Fax Number . Services billed with the following revenue codes always require prior authorization:. Enroll today. Sharing accounts may violate HIPAA regulations regarding data privacy. 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 If it doesn't work, or your doctor doesn’t think they’re appropriate for you, they can submit a prior authorization request for a non-formulary medicine. Blue Care Network HMO 1-800-482-5982. 26, 2024 1 . To learn more, see our Training Tools page. purchased in or shipped to Provider Programs; Prior Authorization Resources; News and Updates; Resources; Training; Change and Enrollment Forms; About Us. Requirements for services provided by non-Michigan providers may vary from those outlined in this document. </p> EviCore by Evernorth leverages our clinical expertise, evidence-based guidelines, and innovative technologies to deliver best-in-class medical benefit management solutions that inform more effective, affordable treatment and site of care decisions for each patient’s needs. 2 . Page 2 of 4. *Clicking this link means that you’re leaving the Blue Cross Blue Shield of Michigan and Blue Care Network website. Determine if medical authorization is required for a Medicare or Medi-Cal member. Some medical services and medications may need a prior authorization (PA), sometimes called a “pre-authorization,” before care or medication can be covered as a benefit. Instead, follow the two-level provider appeal process for Medicare Plus Blue For any questions about prior authorization, please call Customer Service at the number on the back of your Blue Shield member ID card. Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. Providers can get information on how to request a prior authorization through Availity. For Providers: Contact us (bcbsm. You do not need to contact us for a Prior Authorization. about. Pre-admission or prior authorization Prior Authorization Form. Utilization management programs for Michigan If the MESSA Connect System is disabled, please call 800-336-0013 to request a paper registration form. This page Blue Cross Behavioral Health no longer requires autism diagnostic re-evaluations (PDF) Guidelines for billing Avastin for Blue Cross and BCN commercial members (PDF) Epysqli to require prior authorization for most commercial members starting Aug. Find the right contact. Blue Cross Blue Shield %PDF-1. FIS 2288 (10/16) Department of Insurance and Financial Services Page 1 of 2 Blue Cross Blue Shield of Michigan Prior Authorization Request Confidential Information June 2020 If you need these services, contact Blue Cross Complete of Michigan Customer Service, 24 hours a day, 7 days a week at . PA (Prior Authorization) Tab - PDF, Webinar; 102 Resources. (CST) Monday through Friday except holidays. 888-492-6811. Provider Enablement We offer providers with tools and services that impact the quality and safety of your care decisions and reward you for improved outcomes. Blue Cross Blue Shield of Michigan providers, find pharmacy On March 10, we updated it to include information about electronic prior authorization changes for MESSA members. Prior authorization and pharmacy programs listed in this guideline: • BCN Custom Drug List • BCBSM Custom Drug List • BCBSM Clinical Drug List • BCN Custom Select Drug List Michigan’s prior authorization law* requires health care providers to submit prior authorization requests electronically for commercial members. Provider Resources. Disclaimers AZ Blue makes reasonable effort to keep the lookup tool and code lists current. Blue Shield of California Promise Health Plan. Contact Us. If more assistance is needed, Enter the contact name, verify the physician's phone number (including the extension, if applicable) and fax number, and select Continue. Provider Log In. Links to third party websites are provided for Provider portal training video; By fax • Fax a completed Prior Authorization Form to: 512-380-7507. Click the Forms menu and make the appropriate selection. Documents and forms for noncontracted or non-Michigan providers. ) • The drug is not part of the 100% Medicaid Health Plan Carve-Out, which is payable by the State of Michigan and not by Blue Cross Complete. Only provide the physician’s direct contact number and initials if you are requesting an Expedited Review Request. Beginner Guide; CHAMPS FAQs; CHAMPS Navigation Tutorial - PDF, Recording; Prior Authorization Screen Navigation Click Secure Provider Resources (Blue Cross and BCN). Medicare Plus Blue PPO Determining prior authorization requirements for members For Michigan and non -Michigan providers Revised July 3, 2024 1 . What's New for 2024. Providers can submit prior authorization requests via: Portal: Provider Portal (registration is required) Provider portal training video; Fax: 586-693-4768 for Medical Management. Complete these steps: . 1-833-409-1280 . If you believe that Blue Cross Complete of For Blue Cross commercial, Medicare Plus BlueSM, Blue Care Network commercial and BCN AdvantageSM Revised September 2024 1 . Check each member’s eligibility and benefits prior to providing Medical oncology prior authorization list for Blue Cross and BCN commercial members: Medications that require authorization RC Claim Assist is a web-based resource available to Blue Cross Blue Shield of Michigan and Blue Care Network contracted providers who bill for drugs covered under the medical benefit. Contracted with Blue Cross Blue Shield of Michigan or Blue Care Network? Steps; Michigan: Yes: Michigan’s prior authorization law* requires health care providers to submit prior authorization requests electronically. Precertification is also How to submit prior authorization requests *Clicking this link means that you’re leaving the Blue Cross Blue Shield of Michigan and Blue Care Network website. Limited Benefit Dental Plans and Orthodontics Coverage Medically necessary orthodontics services covered by limited benefit dental plans require prior authorization. submit via fax to 1-877-325-5979. Michigan’s . 2024. See the e-referral User Guide to learn how. Phone: 844-217-8191 (available Monday through Friday, 8:00 a. View Blue Shield Prior Authorization list (PDF, 113 KB) ©1996-2024 Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross Blue Shield Association. These programs vary based on member coverage and may be administered by Blue Cross or Northwood is the preferred provider for Blue Prior authorization requests are reviewed by our independent pharmacy benefits manager. Hours: 24 hours a day, seven days a week Phone: 800-977-2273 (TTY 711) *For Medicare-Medicaid Plan pharmacy requests, please contact Anthem Blue Cross Cal MediConnect Plan (Medicare-Medicaid Plan) Customer Care at 855-817-5786. The steps required to determine whether prior authorization, including precertification, is Post-acute care services . Submitting requests for inpatient admissions on holidays. In the eviCore portal, select . If you don’t have access to Availity, you can review other options below. Authorization Call Center Phone Numbers If you wish to contact Evolent (formerly National Imaging Associates, Inc. To request prior authorization, contact Companion Benefits Alternatives (CBA) using one of the below options: Calling 800-868-1032 Contact Humana with questions about your patients` benefits, claims or guidelines for prior authorization. if you’re encountering technical problems when using the Blue Cross Behavioral Health provider portal to submit prior authorization requests. non-oncology diagnosis, don’t. PATIENT INFORMATION PHYSICIAN INFORMATION Name : For prior authorization determinations Revised January 2024 . ** Services that require authorization for Michigan providers For Medicare Plus BlueSM Updated September 2024 3 . Contact J&B at 1-888-896-6233 or jandbmedical. Eligibility, prior authorization and claims. com*or by calling EVOLENT at . For technical support, call the CareFirst Help Desk at (877) 526 – 8390. Contact. COVERAGE AREA - CNY: Cayuga, Cortland, Jefferson, Lewis, Onondaga, Oswego, St. Posting date: 10/30/2020. Submit requests before providing services. D. Phone: (800) 535-9481. BCCHP won’t pay for services from a provider that isn’t part of the BCCHP network if Prior Authorization is not given. Update your contact information Commercial customer service. Payers across the country have selected Availity Essentials™ as their exclusive provider portal, leveraging the power of Availity’s network and platform to improve provider collaboration. To submit prior authorization requests for medical benefit drugs electronically to Blue Cross Blue Shield of Michigan and Blue Care Network, you must use the NovoLogix tool. If you’re experiencing temporary technical problems, such as a power system or internet outage, you can submit requests Blue Cross and Blue Shield of Texas 2615 Calder St, Suite 700 Beaumont, TX 77702-1954 1-800-637-0171, press 3 or 1-713-663-1149 Fax: 713-663-1227 Email to submit provider inquiries and questions. 1-800-424- Who should providers contact if they want to appeal a prior authorization or claims payment Michigan providers: BCN global referral, plan notification and prior authorization requirements For Blue Care Network commercial and BCN AdvantageSM Effective January 2007 | Updated Aug. eviCore is an independent company that provides specialty medical benefits management for BCBSTX. submit the request to Carelon. Power rated #1 in Michigan for Commercial Health Plan Member Satisfaction. Once you’ve accessed the CareCentrix HomeBridge portal for each NPI, you’ll be able Blue Cross Behavioral Health SM manages prior authorizations for behavioral health services (for mental health and substance use disorders) for the following members:. Michigan providers can either call or write to make an appeal or file a payment dispute. 1, 2024, see Autism information for dates of service before Jan. For assistance, please contact the Provider Support Team at: RadMDSupport@Evolent. ; Where and When. Overview . 3. Providers will need to submit a claim to us on the CMS-1500 form or online. Physicians and professionals: 1-800-344-8525. In this document . While we recommend this site, we’re not responsible for its Dental. For Blue Cross Behavioral Health SM manages prior authorizations for behavioral health services (for mental health and substance use disorders) for the following members:. Pharmacy Prior Authorization Center for Medi-Cal:. Fax: (888) 697-8122. If you are a provider in Michigan, contact Blue Cross Blue Shield through our association of doctors and hospitals, including Blue Care Network Michigan provider prior authorization. Medicare Advantage – 877-774-8592. Electronic prior authorization, or ePA, replaces faxing and phone calls so you can focus less on providers outside of Michigan: 800-810-2583 Misuse may result in prosecution. Provider Demographic Updates For information about behavioral health services for dates of service before Jan. All specialty medicines, such as those for complex diseases, require prior Senate Bill 247 would reform the prior authorization process to do the following: Require an insurer to make available, by June 1, 2023, a standardized electronic prior authorization request transaction process. 0240–0249 — All-inclusive ancillary psychiatric; 0513 — Psychiatric clinic (authorization waived for participating (PAR) providers with HCPCS code G0463 — outpatient facility claims); 0901, 0905 to 0907, 0913, 0917 — Behavioral health treatment If you’d like to schedule a peer-to-peer discussion with one of our clinicians, please contact our Peer-to-Peer department at 800-581-3920. Prior Authorization. Clear Inputs. For Blue Shield Promise providers Blue Cross Blue Shield of Michigan’s Medicare Plus BlueSM PPO Provider Manual July through September 2024. Effective 3/12/2024, EviCore will cease processing for Blue Cross Complete of Michigan prior authorization requests. Explore group, individual, Medicare and more. SM. Specialty medicines. Fax: 512-831-5499 for Medical Drugs/Medical Specialty. 1, 2023 Blue Shield of Michigan Commercial (PDF) to learn about the health plans, groups, and settings and scenarios for which prior authorization isn't required. Houston. Access Blue Cross Blue Shield of Michigan’s machine-readable files to download the table of contents that contains web addresses for the JSON format files with in-network negotiated Medical Drug and Step Therapy Prior Authorization List for Medicare Plus Blue and BCN Advantage members (PDF) For more information, contact the plan's Customer Service center. PROVIDER STREET ADDRESS: CITY. To simplify your experience with prior authorization and save time, please submit your prior authorization request to the pharmacy benefits manager through any of the following online portals: CoverMyMeds Blue Cross Blue Shield of Michigan and Blue Care Network have contracted with CareCentrix providers can contact CareCentrix as follows: Contact method Details . Lawrence, Tompkins ©1996-2024 Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross Blue Shield Association. Be prepared: If your provider determines that a service requires prior authorization, they will initiate the process. If you suspect fraud, call: Blue Cross Blue Shield of Michigan PPO 1-877-627-1041 Answered by our partner, New Directions. com. Use the Blue Cross Blue Shield Plan’s Electronic Provider Access router tool to access other Blue Plan’s provider portals for prior authorization reviews for BlueCard members, including our Alternative Health Plan Portfolio members. If you have any questions regarding this process, please contact BCBSM Provider Relations and Servicing or the Medical Drug Helpdesk at 1-800-437-3803 for assistance. Your doctor will need to submit a prior authorization request using one of the following tools: They can contact PerformRx Pharmacy Provider Services at 1-888-989-0057. Michigan Prior Authorization Request Form For Prescription Drugs Instructions . These contacts include claims, customer service, eligibility verification and Here you can request prior authorization, review our nationally accepted evidence-based guidelines, and receive announcements about program updates. We provide health insurance in Michigan. Blue Cross ©1996-2024 Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross Blue Shield Association. Blue Cross Behavioral Health no longer requires autism diagnostic re-evaluations (PDF) Guidelines for billing Avastin for Blue Cross and BCN commercial members (PDF) Epysqli to require prior authorization for most commercial members starting Aug. . Box 2227 . E-referral system maintenance times and what to do. BHTechSupport@bcbsm. Oncology drugs and medical injectables. Provider Programs; Prior Authorization Resources; News and Updates; Resources; Training; Change and Enrollment Forms Providers who want to sign up as a VFC Program provider or who want to learn more about the VFC Program can contact the VFC Coordinator at the MDHHS Division of Immunization at 517-335 Blue Cross Brian Fetterly (315) 731-9671 brian. BCBS Federal Phone Number; Ambetter Claims address and Phone Number; Michigan: 800-344-8525 (Providers) 800-249-5103 (Facilities - Michigan) 800-676-2583 (Facilities - Blue Cross Blue Shield of Michigan providers, submit prior authorization for your Medicare Plus Blue PPO and BCN Advantage patients' prescriptions. Summary: Beginning November 1, If you have questions about this communication, please contact your Blue Cross Complete provider account executive or Blue Cross Complete Provider Inquiry at 1-888-312-5713. 1 of each year. If you have any questions regarding this process, please contact BCBSM Provider Relations and Servicing or the Medical Drug Helpdesk at 1 -800-437-3803 for assistance. Blue Cross Complete Blue Cross Complete of Michigan 4000 Town Center Suite 1300 Southfield, MI 48075 . Author: Blue Cross/BCN Provider Communications Created Date: 4/12/2024 9:16:31 AM Blue Shield of Michigan or Blue Care Network. These requirements apply If you cannot complete your eligibility/benefits inquiry online, please contact us at 800-842-5975. Prior authorization Comments or Questions for Us? If you have comments or questions, we want to help you. Contact For Providers: Contact us (bcbsm. Go To Provider's Hub; EviCore is continually working to enhance your the Blue Cross and Blue Shield Service Benefit Plan brochures for full details. Check out the changes and updates to our plan in 2024. How to submit prior authorization requests. Prior Authorization Code Lists Providers. Dental. Health care providers must submit prior authorization requests before providing services. Blue Shield of California Pharmacy Services P. Fax authorizations will need to be verified for covered services. Find coverage J. com . The provider portal is the preferred method for authorization requests. please contact your dedicated Evolent Provider Relations Blue Cross Complete Provider Manual. 1-800-228-8554 (TDD/TTY: 1-888-987-5832). A Prior Authorization Service Request is the process of notifying BCBSWY of information about a medical service to establish medical appropriateness and necessity of services. Medicare Plus Blue members For Providers Blue Cross Blue Shield of Michigan commercial fully insured groups, select self-funded groups and members with individual coverage* *To determine whether you need to submit prior authorization requests for Blue Cross commercial members, Contact. zation requests cannot be submitted through the tool. m. The facility must participate with Blue Cross (if located in Michigan) or with its local Blue Cross Blue Shield plan (if located outside of Michigan) for its services to be covered. These programs vary based on member coverage and may be administered by Blue Cross or Northwood is the preferred provider for Blue If you’re a provider with multiple locations, you’ll be able to enter only one provider location per prior authorization submission when you access the HomeBridge portal through Blue Cross and BCN’s provider portal. Box 7168 San Francisco, CA 94120-7168. What. Ascension Personalized Care PO Box 1707 Troy, MI 48099 . Through the site, you can: Check member eligibility and benefits; Check claim status; View remittance advice and vouchers; Determine if a prior authorization or referral is required and link to the appropriate application to submit the request ©1996-2024 Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross Blue Shield Association. Call 1-866-309-1719 or write to us using the following address: 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. PATIENT INFORMATION PHYSICIAN INFORMATION Provider Relations Team; Contact Us; GeoBlue 933 First Avenue King of Prussia, PA 19406 Services, LLC (Worldwide Services Insurance Agency, LLC in California and New York), an independent licensee of the Blue Cross and Blue Shield Association. Before you submit for prior authorization on Availity, we recommend that you consult Member Eligibility & Benefits. care management, prior authorization and more. and BCN Advantage. com*) and access the appropriate portal for submitting global referral, plan notification and prior If you're a provider in Michigan, find your Blue Cross Blue Shield forms, drug lists and medical record retrieval documents. Call 1-800-200-4255 (TTY: 711). com) Frequently accessed documents. 5 . Non-Michigan providers: BCN prior authorization requirements in the BCN section of . How to Determine Requirements: Telephone: Call the BlueCard Eligibility line at 1-800-676-2583 and ask to be transferred to the Medical Management Michigan’s prior authorization law* requires health care providers to submit prior authorization requests electronically for commercial members. 2. To request prior authorization, follow the instructions on the document titled Non-emergency air ambulance prior authorization program: Overview for Michigan and non-Michigan providers. You can view benefit details through Benefit The following services always require prior authorization: Inpatient services (elective and urgent) Codes not on the Michigan Medicaid Fee Schedule. Prior Authorization (PerformRx) For prescribers only, for questions regarding prior authorization, or to initiate prior authorization requests, call: 1-888-989-0057 call: 1-888-989-0057 . services that require prior authorization for Blue Cross and BCN members and indicates which entity manages prior authorizations. Prior Authorizations (also referred to as pre-approval, pre-authorization and pre-certification) can be submitted digitally via the authorizaton application in Availity Essentials. Blue Cross Blue Shield of Michigan and BCN Care Network provide utilization management programs. Benefits, premium, copayments or coinsurance may change on Jan.  Providers will have the choice of using either Availity Essentials* or fax to submit prior authorization requests for all medical (non-pharmacy) services. Information for Non-Michigan providers . If you do need to call, please use the phone number that has been designated for your Evolent (formerly National Imaging For prior authorization determinations Revised January 2024 . Select Blue Cross Blue Shield of Michigan commercial and Medicare Plus Blue members. For services provided to Blue Cross Blue Shield of Michigan members on and after May 12, 2023, normal plan rules apply. EST) BlueCard ® (Out-of-Area) members: Use the BlueCard prior authorization router tool in the AZ Blue secure provider portal. 3 — Y0074_IGHCPCSPA_C FVNR 1223 i . • For procedure codes *92920, *92924, *92928, *92933, 92937 and *92943, providers must submit the prior authorization request after the service has been completed, to validate the This procedure code doesn’t require prior authorization for Blue Cross commercial members. Do this prior to the flight. Which DMEPOS products and services require prior authorization?” on Page 4. A standard prior authorization form, FIS 2288, was created by the Michigan Department of Insurance and Financial Services (DIFS) to simplify the process of requesting prior authorization for prescription Blue Cross Complete of Michigan LLC is an independent licensee of the Blue Cross and Blue Shield Association. For Blue Shield providers. You'll need to submit a prior authorization request and follow our medical policies to avoid a rejected claim. ©1996-2024 Blue Cross Blue Shield of Michigan and Blue Care Network are Learn how to contact your local Blue Cross and Blue Shield company, as well as other key areas. 8 (PDF) Changes to the BCN referral and authorization requirements for Michigan providers How to submit prior authorization requests *Clicking this link means that you’re leaving the Blue Cross Blue Shield of Michigan and Blue Care Network website. Search CONTACT US. Contact Clinical Services for inquiries that cannot be handled via the provider portal. Medical Medicare customer service. Blue Cross Behavioral Health ℠ Prior Authorization – Mental health, substance use disorder, and case management 1-877-228-3912. This document explains what providers need to do to request a peer-to-peer review with a Blue Cross Blue Shield of Michigan or Blue Care Network medical director about services for which a prior authorization request This document explains what providers need to do to request a peer-to-peer review with a Blue Cross Blue Shield of Michigan or Blue Care Network medical director about services for which a prior authorization request has been denied by Blue Cross or BCN. CONTACT INFORMATION. Blue Care Network commercial; BCN Advantage SM; Notes: For information about behavioral health for Blue Cross Blue Shield of Michigan commercial and Medicare Plus Blue As a PPO/POS, HMO or Traditional contracted provider with Blue Cross and Blue Shield of Texas, you are responsible for the completion of the prior authorization process for BlueCard members. New York: What if I’m having technical problems when using the Blue Cross Behavioral Health provider portal? Email us at . In your email, include: • Provider’s name, NPI and Tax ID For information about high-tech radiology services for Blue Cross Blue Shield of Michigan commercial and Medicare Plus Blue SM members, see the Blue Cross Radiology Services, High Tech page. • Provide a phone number where the provider can be reached for a peer-to-peer must submit Blue Cross and BCN prior authorization requests through Blue Cross Blue Shield of Michigan Medicare Advantage Grievances and How to submit prior authorization requests *Clicking this link means that you’re leaving the Blue Cross Blue Shield of Michigan and Blue Care Network website. I need to contact. Who requests prior authorization? Usually, the provider is responsible for requesting prior authorization before performing a service if the member is seeing an in-network provider. who reside in Michigan and who receive services from Michigan providers. PATIENT INFORMATION PHYSICIAN INFORMATION Use these numbers for claims and other inquiries for Blue Cross Community Health Plans SM (BCCHP SM), Blue Cross Community MMAI (Medicare-Medicaid Plan) SM and Blue Cross Medicare Advantage SM (HMO and PPO). Note: If this list specifies that you should submit a prior authorization request to Carelon but you’re prescribing the drug for a . Prior Authorization is required before these drugs are administered in these locations: a doctor's office, at home, outpatient hospital, ambulatory surgical center or a health clinic. Medicaid customer service. Blue Cross Blue Shield of Michigan and Blue Care Network are changing how we approach coverage of glucagon-like peptide-1 receptor agonist , known as GLP-1, drugs indicated for weight loss for our fully insured large group commercial This tool will guide you through the steps performed in submitting authorization requests for Home Health services for Blue Cross Blue Shield of Michigan, using the CareCentrix HomeBridge Portal: Requesting an Initial or Prior Authorization; Requesting a Reauthorization or Continuation of Services; Editing an Authorization By Phone: Call the number on the back of the member’s ID card or dial 800-676-BLUE (2583) to speak to a Provider Service representative. For BlueCard members from other Blue Plans. Submitting a prior authorization request. to 8 p. Please Select Your State The resources on this page are specific to your state. Section 2212e(17)(n) defines “standardized electronic prior authorization transaction process” as “a standardized transmission process, identified by the director and aligned with standards that are nationally accepted, to enable prior authorization requests to be accessible, submitted by health care providers, and accepted by insurers or their <p>Prior authorization request information for healthcare providers. Healthy You! Provider Information » Blue Cross & Blue Shield of Mississippi does not control such third party websites and is not responsible for the content, advice, products or services offered therein. For • For medical oncology and supportive care drugs, you’ll submit prior authorization requests to Carelon Medical Benefits Management. To view utilization management criteria, go to the Services That Need Prior Authorization page on bcbsm. See the following documents for prior authorization requirements. Note: If the acute care provider isn’t contracted with the member’s health plan, the post- eviCore healthcare ® is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to manage prior authorizations for select services. ET Monday through Friday • If non-emergency air ambulance transport is needed, prior authorization is required. CO 15 Denial Code – The authorization number is missing, invalid, or does not apply to the billed services or provider BCBS Provider Phone Number. For general inquiries and questions about the Service Benefit Plan, our overseas and pharmacy coverage or fraud assistance, you can call us toll-free nationwide. Log in to This will take you to the Blue Cross Blue Shield of Michigan website. Services which may require Prior Authorization. Some medicines require prior authorization by Blue Cross Complete. Care Management. If you have this type of dental coverage, your plan information will have one of these numbers on the first page: 97176EX-039 or 97176EX-040. Learn More Third Party Website Icon: Please be aware when you are on the Blue Cross and Blue Shield of Minnesota (Blue Cross) website and see this Third Party Website icon, you will be connected to a third party site, whether via links provided by Blue Cross or otherwise, and you will be subject to the privacy policies of the third party sites. Prior authorization via fax Inpatient authorization fax information. 7 %âãÏÓ 1 0 obj >/PageTransformationMatrixList >/PageUIDList >/PageWidthList >>>>>/Resources 314 0 R/Rotate 0/StructParents 1/Tabs/S/TrimBox[0 0 612 792 4. ) is responsible for. Note: Your Availity account and login credentials belong only to you. for urgent issues. To learn how to submit requests, see our Getting Started page. authorization as well as view BCBS Provider Phone Number April 23, 2020 Channagangaiah CMS 1500 blocks instructions in Medical Billing BCBS Federal Phone Number Provider Inquiry is for registered, nonregistered and out-of-state providers. Prior authorization will become less of a hassle for physicians in Blue Cross Blue Shield of Michigan’s network, BCBSM officials hope, as they roll out an effort to relax about 20% of prior How to submit prior authorization requests *Clicking this link means that you’re leaving the Blue Cross Blue Shield of Michigan and Blue Care Network website. General Pharmacy Benefit Information They have access to Highmark’s prior authorization list on the Provider Resource Center, and the ability to check your benefits via Availity, our provider portal. For information about provider of diabetes supplies. Failure to obtain prior approval will result in a $100 penalty. P. com to request changes to existing practice information. Contact; Online tools to assist you. Phone – Call the Carelon Contact Center at 866-455-8415, Monday through (eviCore): Prior authorization requests for our Blue Cross Medicare Advantage (PPO Blue Cross Blue Shield of Michigan and Blue Care Network provide utilization management Prior authorization requirements for Michigan and non-Michigan providers Blue Cross/BCN Provider Communications Created Date: 8/8/2024 9:33:57 AM Prior Authorization Nondiscrimination Notice Stop Fraud Tax Forms Resources and Tools Contact Us Find Care Get Help Forms and Documents Machine Readable Files Podcast Get Mobile App Get a Quote Our Sites ©1996-2024 Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees Use the Find a Doctor search tool to locate in-network SmartHealth providers and locations near you. BCCHP – 877-860-2837. to 6:00 p. ; Saturday & Sunday 8:30 a. Claims. If you have questions or need assistance, please contact your Provider Experience Consultant or contact Provider Services at 844-912-1226. Page 3 of 4. Alternate submission methods (phone or fax) are Blue Cross commercial . com) Blue Cross Blue Shield of Michigan and Blue Care Network are changing how we approach coverage of glucagon-like peptide-1 receptor agonist, known as GLP-1, drugs indicated for weight loss for our fully insured large group commercial members. Authorization requests that do not include documentation of medical necessity or failure of formulary alternatives, as applicable, will be denied. Blue Cross Behavioral HealthSM manages prior authorizations. Refer to Post-acute care services: Frequently asked questions by providers (PDF) for information about the Home & Community Care program and to learn how to submit retroactive authorization requests Blue Cross Blue Shield of Michigan’s Medicare Plus BlueSM PPO Provider Manual Revised January 1, 2022. Make sure to bill drugs under the medical benefit for the administration fee with an HCPCS code (J, S, 90000, etc BCC_PRIORAUTHREQ_WEBSITE001_20181009 ME-61Rev102318 Blue Cross Complete of Michigan authorization requirements The following services require your doctor to contact Blue Cross Complete for permission to treat Blue Cross Blue Shield/Blue Care Network of Michigan Medication Authorization Request Form. For information about cardiology services for Blue Cross Blue Shield of Michigan commercial and Medicare Plus Blue SM members, see the Blue Cross Sleep Studies page. eviCore staff will contact the provider and will also notify the provider of the determination. If you are a provider in Michigan, learn more about Blue Cross Blue Shield's specialty pharmacy program and specialty drug program member guide. • For Blue Cross commercial and Medicare Plus Blue members: Prior authorization requirements for Michigan and non-Michigan providersDFP Prior Authorization rules - Medicare Advantage Medical / Surgical/Behavioral Health** through Blue Cross and Blue Shield of Texas call toll free 1-877-774- 8592 between 8 a. Provider alert Blue Cross commercial and BCN commercial Category: Authorizations/referrals Date posted: March 1, 2023 | Updated: March 15, 2023 1 . Non-Michigan providers: Referral and authorization requirements for BCN members (PDF) For Providers: Forms and Documents page on bcbsm. For Blue Cross commercial . This tool will guide you through the steps performed in submitting authorization requests for Home Health services for Blue Cross Blue Shield of Michigan, using the CareCentrix Providers can submit prior authorization requests for Blue Cross Blue Shield of Michigan members through their local Blue plan’s electronic portal via the Electronic Provider Michigan providers: Look up requirements for a member who has coverage through Blue Cross Blue Shield of Michigan or Blue Care Network. • Provide a phone number where the provider can be reached for a peer-to-peer must submit Blue Cross and BCN prior authorization requests through Blue Cross Blue Shield of Michigan Medicare Advantage Grievances and ATTENTION: If you speak a language other than English, language assistance services are available to you free of charge. Select the prior authorization program for which you’re submitting a prior authorization request. 1, 2024, prior authorization requests are managed by Blue Cross Blue Shield of Michigan or Blue Care Network. Request a Clinical Certification to start the process. Some prescriptions may require prior authorization or prior plan approval. Alternate submission methods are allowed in the case of temporary technological problems, such as power or internet outages; see the information about submitting prior authorization requests The following outlines the process for providers to submit prior authorization requests. CONTACT US. You can work with an out-of-network provider to receive Prior Authorization before getting services. Physical health: 877-643-0671 Save time and submit your prior authorization requests Blue Cross Blue Shield of Michigan and Blue Care Network members. By taking advantage of a multi-payer provider portal, you not only free up internal resources to focus on mission-critical activities, but you leverage Title: Prior Authorization Lookup Tool Available . Provider / prescriber information . If you’re requesting prior authorization Determine prior authorization requirements for members. you must call the phone number on the Member's ID card to complete a Retrospective Review. Blue Cross Blue Shield of Michigan and Blue Care Network require health care providers to obtain approval before providing certain Medical oncology prior authorization list for Blue Cross and BCN commercial members: Medications that require authorization RC Claim Assist is a web-based resource available to Blue Cross Blue Shield of Michigan and Blue Care Network contracted providers who bill for drugs covered under the medical benefit. By phone. Prior authorization should continue to be requested by dialing 1-888-312-5713 (opti. Get notification lists and download state-specific lists. Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association. UTILIZATION MANAGEMENT . Blue Card Access - National Provider Network. CareSource® evaluates prior authorization requests based on medical necessity, medical appropriateness and benefit limits. Please Select Your State If you need help choosing a plan, you can talk to one of our health plan advisors by calling: 1-888-563-3307 TTY users: 711 8 a. Note that the following utilization management requirements resume on July 1, 2023: How to submit prior authorization requests *Clicking this link means that you’re leaving the Blue Cross Blue Shield of Michigan and Blue Care Network website. If you have any questions regarding this process, please contact BCBSM Provider Relations and Servicing or the Medical Drug Helpdesk at Healthy Blue is a Medicaid plan offered by Blue Cross and Blue Shield of North Carolina. fetterly@excellus. STATE: ZIP. a prior authorization is not required through this process. without a prior authorization request. Michigan prescribers To submit prior authorization requests electronically, first register for Availity ® Essentials, our provider portal; refer to the These machine-readable files include negotiated rates for in-network providers and allowed amounts and historical billed charges for out-of-network providers. Service Contact information Behavioral health . Services requiring prior authorization through We would like to show you a description here but the site won’t allow us. please contact BCBSM Provider Relations and Servicing or the Medical Drug Helpdesk at 1-800-437-3803 for assistance. Obtain Authorization Authentication Required Procedure codes for which providers must request prior authorization For Blue Cross commercial, Medicare Plus BlueSM, BCN commercial and BCN AdvantageSM v. The result: Better outcomes and lower costs for patients, providers, and plans. Prior Authorization: Inquiry; Additional Resources. Provider Submitting prior authorization requests for medical benefit drugs . Name: Legal name: Type 1 (individual) NPI: Tax ID number: Street address 1: Street address 2 How to submit prior authorization requests *Clicking this link means that you’re leaving the Blue Cross Blue Shield of Michigan and Blue Care Network website. ereferrals. bcbsm. The document below lists prior authorization codes for Blue Shield (including Medicare 65+). O. New prior authorization requests will be required, and new prior authorization criteria will PROVIDER PHONE NUMBER : PROVIDER FAX NUMBER . This document provides contact information for Blue Cross Blue Shield of Michigan and Blue Care Michigan’s prior authorization law* requires health care providers to submit prior authorization requests electronically. Providers can request prior authorization online at RadMD. TTY users call 711 You can also view Blue Shield’s prior authorization list or contact Blue Shield of California Provider Services to determine if medical authorization is required. Vision and For information about musculoskeletal services for Blue Cross commercial and Medicare Plus Blue SM members, see the Blue Cross Musculoskeletal Services page. Prior Authorization Request Form BCC_211400484-1 . For a list of these drugs, please click here or contact the Customer Service number on your member ID card. provider can request prior authorization, including primary care providers, acute care providers For dates of service on or after Oct. Click Secure Provider Resources (Blue Cross and BCN). Prior Authorization Submission- Video; Prior Authorization Inquiry- Video; Quick Reference Guides. Update: Prior authorization changes coming in June . (2) musculoskeletal surgical and other related procedures for Blue Cross Blue Shield of Michigan and Blue Care Network. The following information describes the general policies of Blue Cross Blue Shield of Wyoming and is provided for reference only. Michigan’s prior authorization law* requires health care providers to submit prior authorization requests electronically for commercial members. All other marks are the property of their respective owners. Group coverage is provided under insurance policies underwritten by 4 Ever Life Insurance Blue Cross Blue Shield of Michigan commercial; (PDF) to learn about the health plan, groups, and settings and scenarios for which prior authorization isn't required. Prior Authorization Request Form. Important: If these members don’t use the Northwood network, they may have higher out-of-pocket costs. Home . Services requiring prior authorization Most preauthorization requests can be resolved by contacting Provider Relations and Servicing, or PRS, and requesting member benefits. To view Blue Cross and BCN’s medical policies, go to the Medical This section states how to log in to our provider portal (availity. FACILITY NAME : FACILITY TIN . June 2020. non-Michigan providers must contact BCN Utilization Management at 1- 800-392-2512 prior to performing the surgery. You can work with your doctor to submit a Prior Authorization. Blue Cross Blue Shield of Michigan . Note: Prior authorization requests for medical oncology and supportive care Provider Payments Information on the direct deposit of State of Michigan payments into a provider's bank account. to 9 p. TurningPoint Healthcare Solutions LLC is an independent company that manages prior authorizations for musculoskeletal surgical and related procedures for Blue Cross Blue Shield of Michigan and Blue Care Network. Should you have any questions, please contact Blue Cross Complete of Michigan Utilization Management at 1-888-312-5713 (press 1 then 4). Enter the member’s three-character prefix to be routed to their Blue Contact us for drug formulary information and to request prior authorization for outpatient prescription drugs and home self-administered injectables. Find authorization and referral forms. Alternate submission methods are allowed in the case of temporary technological problems, such as power or internet outages; see the information about submitting prior authorization requests Submit Medical Prior Authorization Request » Contact Us; Provider Links. PROVIDER STATUS ____ PAR ____ NON PAR ____ IN CREDENTIALING. MMAI – 877-723-7702. ® Marks of the Blue Cross and Blue Shield Association. 1, 2024 (PDF). Providers may also use Availity Essentials to check the status of a prior authorization request. The Blue Cross and Blue Shield Federal Employee Program® (FEP®) announced today that it will waive cost-sharing for coronavirus diagnostic testing, waive prior authorization requirements for treatment and take other steps to enhance access to care for those needing treatment for COVID-19 to ensure its members can swiftly access the right care BCC_PRIORAUTHREQ_WEBSITE001_20181009 ME-61Rev102318 Blue Cross Complete of Michigan authorization requirements The following services require your doctor to contact Blue Cross Complete for permission to treat Providers contracted with Anthem Blue Cross and Blue Shield (Anthem) should utilize Availity’s Provider Demographic Management (PDM) application hosted on www. Behavioral health. Refer to the . Prior authorization is required for partial hospitalization treatment and must meet medically necessity, use and quality criteria. Prior authorization is required for outpatient radiation oncology procedures. Ask your provider to go to Prior Authorization Requests to get forms and information on services that may need approval before they prescribe a specific medicine, medical cover GLP-1 drugs for weight loss may continue using their current prior authorization criteria. Hours of Availability: Delaware, Pennsylvania, and West Virginia: Monday-Friday 8:30 a. If you’re experiencing temporary technical problems, such as a power system or internet outage, you can submit requests This document provides contact information for Blue Cross Blue Shield of Michigan and Blue Care Michigan’s prior authorization law* requires health care providers to submit prior authorization requests electronically. Alternate submission methods (fax or phone) are Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association. Here's what you need to know about Blue Cross and Blue Shield of North Carolina's coverage. The steps required to determine whether prior authorization, including precertification, is eviCore for Blue Cross and BCN document to learn how non-Michigan providers can access the eviCore provider portal. ©1996-2024 Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross Blue Shield Association. -7 p. Note: To view prior authorization requirements for MESSA members, see the document titled for Michigan providers For Blue Cross commercial, Medicare Plus Blue SM, Blue Care Network commercial and BCN Prior authorization for behavioral health services. availity. Blue Cross Blue Shield of Michigan commercial fully insured groups and individual members for dates of service on or after Sept. ) directly, please use the appropriate toll-free number for the respective health plan. Alternate submission methods are allowed in the case of temporary technological problems, such as power or internet outages; see the information about submitting prior authorization requests The Prior Authorization criteria for drugs indicated on the Medicaid Health Plan Common Formulary as requiring PA is below: Drug PA Criteria . Blue Cross Blue Shield of Michigan commercial; Medicare Plus Blue SM; Notes: For information about behavioral health for Blue Care Network commercial and BCN . Detroit, MI 48231-2227 . Blue Cross and Blue Shield of Texas (BCBSTX) has contracted with eviCore healthcare (eviCore)* to provide certain utilization management prior authorization services for our government programs. Requests for services that require mandatory prior authorization Whether you need help filing a claim or checking your patient's benefits, we can connect you with the right contact. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. Michigan’s prior authorization law requirements* go The Resource Guide (PDF) provides the most commonly used contacts for Blue Cross Complete. For Medicare Plus Blue. The requirements outlined above don’t apply to the UAW Retiree Health Care Trust (group number 70605) or the UAW International Union (group number 71714). oytca ccdxe myvaq hip kmgst tfhx aefmf wxiwk lfryxb sfxs