Ereferrals.bcbsm. To ensure continued access for current e-referral users. You m...

- For Blue Cross and BCN members in groups subject to

DF 15994 JUN 18 Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. R080760 Physician Choice PPO provides access to: • More than 30 OSCs, 4,000 primary care doctors, 11,000 specialists and 100 hospitals • The entire Blue Cross PPO network • Out-of-network doctors and facilitiesOnline 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.Blue Cross and BCN quantity limits for medical drugs. For information on additional drugs that require prior authorization for UAW Retiree Medical Benefits Trust members with Blue Cross non-Medicare plans, see the . Medical oncology prior authorization list for UAW Retiree Medical Benefits Trust PPO non-Medicare members.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 ...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.We also added and updated corresponding preview questionnaires on the ereferrals.bcbsm.com website. New questionnaires. ... Gastric pacing / stimulation - This questionnaire now opens for BCN commercial members for procedure codes *43647, *43648, *43881, *43882, *64590 and *64595.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 ...Blue Care Network commercial and BCN AdvantageSM July 2023 4 . Questions that pertain to all requests This section has questions that pertain to authorization requests for Blue Cross Blue Shield of Michigan commercial, Medicare Plus Blue, Blue Care Network commercial and BCN Advantage members. Which hospitals do the 2022 Local Rules apply to? TheCall 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 CarelonTo 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.Starting Oct. 1, AIM Specialty Health ® to manage cardiology and high-tech radiology services for Blue Care Network. 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 ...ereferrals.bcbsm.com. website. As a reminder, we use our authorization criteria, our medical policies and your answers to the questionnaires in the e-referral system when making utilization management determinations on your authorization requests. New questionnaire . On March 26, we'll add a . Breast reductionproviders please contact [email protected] or 800-437-3803 and ask for Kristy S. for further assistance) 2. After 10 days: Go to Ereferrals.bcbsm.com select Login (green button); you will be re-directed to Provider Secured Services. 3. On the Provider Secured Services screen look for the following link: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 ...ereferrals.bcbsm.com. They can also be accessed on the Quick Guides page located in the BCN Provider Publications and Resources website within. Provider ...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 ...Access this document via ereferrals.bcbsm.com to ensure you're viewing the most up-to-date information. Outpatient PT, OT and ST, and physical medicine ... eviCore healthcare 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 ...Page i BCN Provider Manual (BCN commercial and BCN Advantage) Revised August 2023 . BCN Provider Manual – 2023 BCN commercial and BCN AdvantageSM. BCN Advantage . This chapter is subject to change. To ensure that you review the most current version, we ... bcbsm.com, ereferrals.bcbsm.com, MiBlueCrossComplete.com, …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 ...Blue Cross 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 request ...BCN commercial and BCN AdvantageSM requests. January 2021 . 1. Check the category that applies to your request: For non-behavioral health facility inpatient admissions: Check one (below), then complete the form and fax it to 1-866-373-9468 or email it to . [email protected]. Note: Effective Jan. 4, 2021, peer-to-peer review requests …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.• BCN Medical-Benefit Drugs If you need help with the NovoLogix tool, contact the Web Support Help Desk at 1-877-258-3932. *Clicking this link means that you're leaving the Blue Cross Blue Shield of Michigan and Blue Care Network website. While we recommend this site, we're not responsible for its content. Availity ®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 onereferrals.bcbsm.com. They are dated May 2022. Blue Cross Blue Shield Blue Care Network @ of Michigan Nonprofit corporations and independent licensees ... Author: Blue Cross Blue Shield of Michigan and Blue Care Network Created Date: 5/24/2022 8:31:08 AM ...Blue Cross Blue Shield of Michigan Blue Cross Blue Shield of Michigan implemented InterQual acute care, rehabilitation, long-term acute care and skilled nursing criteria effective Aug. 2, 2021. On this date, the modifications outlined below took effect and all previous modifications and InterQual criteria were replaced with these guidelines. All prior authorization requests must beThe standard BCN ID card layout ID cards for BCN products include the following: > Subscriber Name: Name of the subscriber or member. > Subscriber ID: Alphanumeric identifier composed of a three‑character BCN prefix followed by a BCN‑issued contract number. Use this number for billing and checking eligibility and benefits.Blue Cross Blue Shield of Michigan and BCN 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 right 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.BCN Behavioral Health Discharge Summary For BCN HMOSM (commercial) and BCN AdvantageSM Revised February 2018 Contracted providers: Complete this form and attach it to the case in the e-referral system, in the Case Communication field. Facility name / location: Contact phone: Contact name: BCN enrollee ID number: Patient name: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 documentationIn mid-May, ereferrals.bcbsm.com is launching a makeover. All the news, forms and information you've come to expect from the site will still be available, but we hope you'll find the new colors and photos more appealing. A new search feature will make the site easier to use. We're also adding a new section for Blue Cross content. Here's a ...benefit for Blue Cross Blue Shield of Michigan and Blue Care Network commercial members. Michigan prescribers . To submit prior authorization requests electronically, first register for Availity ® Essentials, our provider portal; refer to the . Register for web tools. page at bcbsm.com for details. Then: 1. Log in to availity.com*. 2. Click ...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 on Currently, both eviCore's electronic system and BCN's e-referral system show the same number of units authorized by eviCore. Beginning Aug. 18, 2016, in some instances, you may see 250 units authorized in BCN's e-referral system for each service approved by eviCore. ... Additional information is available at ereferrals.bcbsm.com. Click BCN ...Musculoskeletal Services. . Musculoskeletal Services. Providers must obtain authorization from TurningPoint Healthcare Solutions LLC for: Orthopedic procedures. Pain management procedures. Spinal procedures. This requirement applies to: Blue Cross commercial fully insured groups, select self-funded groups and members with individual coverage*.For BCN commercial members, fax to 1-866-601-4425. For BCN Advantage members, fax to 1-800-459-8027. Call the Blue Cross and BCN Pharmacy Clinical Help Desk at 1-800-437-3803. For BCN commercial members only, mail the request to: BCBSM Clinical Help Desk.Blue Cross Blue Shield of MichiganFebruary 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.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 …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.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 ...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.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)A global referral allows a specialist contracted with Blue Care Network to perform necessary services to diagnose and treat a member in the office as long as those services do not require prior authorization or benefit review. The specialist may also order diagnostic tests and/or schedule elective surgery at a facility as long as those services ...Shield of Michigan and BCN can contact Availity to get access to Blue Cross and BCN information as if they’re a Michigan provider. Ancillary providers who have taken this step should follow the instructions in the . Michigan . providers: Look up requirements for a member who has coverage through Blue Cross Blue Shield of Michigan orApril 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 ...Blue Care Network commercial and BCN AdvantageSM March 2023 1 . 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 aprior authorization request has been denied by Blue Cross or BCN.A global referral allows a specialist contracted with Blue Care Network to perform necessary services to diagnose and treat a member in the office as long as those services do not require prior authorization or benefit review. The specialist may also order diagnostic tests and/or schedule elective surgery at a facility as long as those services ...©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.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 ...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.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.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 Behavioral Health Discharge Summary For BCN HMOSM (commercial) and BCN AdvantageSM Revised February 2018 Contracted providers: Complete this form and attach it to the case in the e-referral system, in the Case Communication field. Facility name / location: Contact phone: Contact name: BCN enrollee ID number: Patient name:Access this document via ereferrals.bcbsm.com to ensure you're viewing the most up-to-date information. Pain management : For non-hospice palliative care and ... procedures for Blue Cross Blue Shield of Michigan and Bl ue Care Network. Title: Blue Cross and BCN - Pain management: For non-hospice palliative care and for musculoskeletal-related ...Additional referral information appears in the BCN Advantage and Behavioral Health chapters of the manual. The BCN Provider Manual is updated regularly. Updates are designated within the chapters as "Blue Dot" changes. You can identify Blue Dot changes by a blue-dot icon accompanied by a brief explanation of the change in a bold blue text box.Shield of Michigan and BCN can contact Availity to get access to Blue Cross and BCN information as if they’re a Michigan provider. Ancillary providers who have taken this step should follow the instructions in the . Michigan . providers: Look up requirements for a member who has coverage through Blue Cross Blue Shield of Michigan orCarelon Medical Benefits Management is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to manage prior authorizations for select services. For more information, go to our . ereferrals.bcbsm.com. website.Blue Cross Blue Shield of MichiganApril 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 ... 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 CarelonBlue Cross Blue Shield of Michigan 600 E. Lafayette Blvd., Detroit, MI 48226-2998 A nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association Use of this card is subject to terms of applicable contracts, conditions and user agreements. Dental, Vision and Pharmacy providers: file claims according to your networkTo find the CareCentrix training, search on "home health care" and then click the Courses tab. To request access to the provider training site: Click here to register .*. Complete the registration. We recommend using the same email you use to communicate with Blue Cross for provider-related needs. This will become your login ID.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 :The information in this document applies to Blue Cross Blue Shield of Michigan commercial members and Blue Care Network commercial members admitted to post-acute care (to a skilled nursing facility, an inpatient rehabilitation facility or a long-term acute care hospital). Note: For Medicare Plus Blue and BCN Advantage members admitted to post-acuteGo to ereferrals.bcbsm.com. Click Blue Cross. Click Medical Benefit Drugs. Scroll to the Blue Cross commercial column. Review the information in the "How to submit authorization requests electronically using NovoLogix" section. More about the authorization requirements. Authorization isn't a guarantee of payment.ereferrals.bcbsm.com, at these locations: • Blue Cross Medical Benefit Drugs page • BCN Medical Benefit Drugs page Authorization isn't a guarantee of payment. Health care practitioners need to verify eligibility and benefits for members. *Clicking this link means that you're leaving the Blue Cross Blue Shield of Michigan and Blue CarePage 1 and 2: User Guide e-referral on the iEXCHA Page 3 and 4: Table of Contents Section I: Gettin Page 5 and 6: Logging in Enter your ID (usually t Page 7: …Medicare Plus BlueSM, BCN commercial and BCN AdvantageSM Category: Authorizations/referrals Date posted: April 18, 2023 1 . Updated questionnaires in the e-referral system, starting April 24 . On April 24, 2023, we'll update questionnaires in the e-referral system. We'll also update the corresponding preview questionnaires on . ereferrals ...Musculoskeletal Services. . Musculoskeletal Services. Providers must obtain authorization from TurningPoint Healthcare Solutions LLC for: Orthopedic procedures. Pain management procedures. Spinal procedures. This requirement applies to: Blue Cross commercial fully insured groups, select self-funded groups and members with individual coverage*.codes that require authorization by TurningPoint" document on ereferrals.bcbsm.com. One authorization will cover both the setting and the procedure. The facility does not need to submit a separate authorization. The ordering physician should secure the required authorization and provide the authorization numbers to theBlue Cross Blue Shield of Michigan and Blue Care Network offer care management programs 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. • Care management programs provide patient support by identifying ...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 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: …This requirement applies to all BCN-participating freestanding diagnostic facilities, outpatient hospital settings, ambulatory surgery centers and provider offices that provide these services, for BCN commercial and BCN Advantage members (except for physical medicine- 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. Carelon-Managed Procedures (formerly AIM) ProUpdated: Blue Cross continues to pay claims during our For BCN commercial and BCN Advantage members, call 1-844-377-1278. For Blue Cross commercial and Medicare Plus Blue members, call 1-800-728-8008. If Carelon is unable to accept requests by phone due to technical problems, submit the request to Blue Cross or BCN using one of the following methods: View everything Blue Cross Blue Shield of Mic ©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. The information in this document applies to Blue Cross ...

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