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For Medicare Plus Blue members, fax to 1-866-601-4428. 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: BCBSM Clinical Help Desk. P.O. Box 312320.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.healthcare for Blue Cross and BCN. You can submit retroactive authorization requests to eviCore healthcare ® through July . 29, 2022, for dates of service prior to April 1, 2022. Additional information is available on the . eviCore-Managed Procedures page. in the Blue Cross section at ereferrals.bcbsm.com. Post-acute care servicesApril 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 ...

BCBSM Clinical Help Desk P.O. Box 312320 Detroit, MI 48231-2320 Need additional assistance? Here's who you can call: For questions about utilization management requirements, call the Blue Cross / BCN Pharmacy Clinical Help Desk at 1-800-437-3803. For questions about the CoverMyMeds web tool, call the CoverMyMeds support center …ATTN: BCN Advantage Grievances and Appeals Unit . P.O. Box 284 . Southfield MI 48076-5043 . Fax: 1-866-522-7345 . Phone: 1-800-450-3680 . BCN will process these appeals using the normal BCN Advantage appeal processes for standard and expedited appeals.High-tech radiology — This includes procedures for Michigan Blue Cross and Blue Shield Federal Employee Program ® members. In-lab sleep management — Blue Cross Commercial. Proton beam therapy. Echocardiogram services. Medical oncology - This applies to the following: Medicare Plus Blue members.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 risks

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 and BCN L ocal Rules for 2022 (non-behavioral health) Modifications of InterQual® acute care criteria For Blue Cross commercial, Medicare Plus BlueSM, Blue Care Network commercial and BCN AdvantageSM Effective March 1, 2022, through July 31, 2023 Published December 2021 / Updated July 2023 1 . In this document ….

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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 :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 risks

Blue Cross/BCN Provider Communications Created Date: 20221111145255Z ...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 tool must ...

deidar ffxiv 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 Cross vip nails woodbury njoutlaws mc territory map • ereferrals.bcbsm.com: For referral and authorization requirements, select BCN and then Blue Elect Plus POS. • By phone, call Provider Inquiry • To send BCN electronic claims, call 1-800-542-0945. • To send paper claims, mail to: BCN Claims, P.O. Box 68710, Grand Rapids, MI 49516-8710. Blue providers outside Michigan: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). virgo sun cancer rising TurningPoint reviews this procedure code for BCN commercial and BCN Advantage members for dates of service on or after June 1, 2020, through March 25, 2023. TurningPoint reviews this procedure code for Medicare Plus Blue members for dates of service on or after Jan. 1, 2021, through March 25, 2023. For dates of service onBlue Cross Blue Shield of Michigan 600 E. Lafayette Blvd. Mail Code CS3A Detroit, MI 48226-2998 Fax: 1-877-348-2210 To submit the appeal, please complete the Member Appeal Form and include the Designation of Authorized Representative for Appeal form. Include clinical information and any medical records that will assist us in making a map of the glade maze runnervirginia beach weather 30 day forecastenterprise colonie ny Quick Guides. e-referral Quick Guide ( PDF) - A brief overview of what you need to know to start using the e-referral tool. Care management and utilization management programs: Overview for providers ( PDF) - Overview of care management programs for members and utilization management programs for providers. BCN Provider Inquiry Contact ...Carelon-Managed Procedures (formerly AIM) Providers must obtain authorization from Carelon Medical Benefits Management (formerly AIM Specialty Health ®) for the following services: Cardiology services - Medicare Plus Blue SM. This includes cardiac implantable devices and services. High-tech radiology - This includes procedures for Michigan ... timber ninja c1 You can access this document from the ereferrals.bcbsm.com website, on these webpages: Blue Cross Authorization Requirements & Criteria page. BCN Authorization Requirements & Criteria page. Here are the additional upcoming closures that will occur during 2021, so you can plan ahead: Good Friday - Friday, April 2. Memorial Day - Monday, May 31. kaiser puyallupa dog's purpose full movie freeschofield lemon lot September 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)June 2018. e-referral system is pending outpatient authorization requests for patients with the Blue Cross Blue Shield of Michigan plans. Updated authorization criteria and e-referral questionnaires are in effect. Effective Oct. 1, Prolia ® and Xgeva ® are subject to a site-of-care requirement for BCN HMO SM members.