Ereferrals.bcbsm.

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.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) 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 beStarting May 18, 2023, we're adding a prior authorization requirement for most Blue Cross Blue Shield of Michigan and Blue Care Network group and individual commercial members for the following drug covered under the medical benefit: • Qalsody (tofersen), HCPCS code J3590 ... ereferrals.bcbsm.com website: • Blue Cross Medical Benefit Drugs .Physicians and professionals: 1-800-344-8525. Hospitals or facilities: 1-800-249-5103. Vision and hearing providers: 1-800-482-4047. Federal Employee Program providers and facilities: 1-800-840-4505. While our automated response system is available to any provider who needs it, we strongly encourage providers to log in or learn how to get an ...

eviCore-Managed Procedures. For Blue Cross commercial and Medicare Plus Blue members, providers must obtain authorization from eviCore healthcare ® for outpatient radiation oncology. Refer to the resources below for more information: Procedure codes that require authorization by eviCore healthcare (PDF) — List of procedure codes eviCore reviews.To 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.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 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 ...Need help? If you need help registering for Availity Essentials, call Availity Client Services at 1-800-AVAILITY (282-4548). Assistance is available 8 a.m. to 8 p.m. Eastern time Monday through Friday, excluding holidays. Were you looking for information on web-DENIS or Provider Secured Services? Availity Essentials replaced them as our ...

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 riskscodes 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 theSeptember 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) PAIN MANAGEMENT EPIDURAL STEROID INJECTIONS AUTHORIZATION REQUEST FORM Utilization management toll-free phone: 1-833-217-9670 Utilization management local phone: 313-908-6040

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 …

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, …

Yes, BCN will be loading some of the information contained on the previous e-referral system into the new system. Cases beginning Jan. 1, 2013 will be loaded into the new system. This includes cases spanning Jan. 1, 2013 - meaning cases that were authorized to start prior to Jan. 1, 2013 and extend beyond Jan. 1, 2013.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 ...Musculoskeletal Services. Providers must obtain authorization from TurningPoint Healthcare Solutions LLC for: Orthopedic procedures. Pain management procedures. Spinal procedures. This requirement applies to BCN commercial and BCN Advantage SM members. For information about musculoskeletal services for Blue Cross commercial and Medicare Plus ...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.ereferrals.bcbsm.com or on our Provider Resources site under Member Care > Behavioral ... 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. ...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 services Access the e-referral tool through our provider portal. Log in at availity.com *. Click Payer Spaces at the top. Click the BCBSM BCN logo. Look for e-referral on the Applications tab of our Payer Space.

©1996-2023 Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association. We provide health insurance in Michigan.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 will not Blue Cross Blue Shield of Michigan and Blue Care Network provide utilization management programs. These programs vary based on member coverage and may be administered by Blue Cross or BCN staff or by contracted vendors. Utilization management programs focus on ensuring that patients get the right care at theBlue Cross Blue Shield of Michigan and Blue Care Network provide utilization management programs. These programs vary based on member coverage and may be administered by Blue Cross or BCN staff or by contracted vendors. Utilization management programs focus on ensuring that patients get the right care at theTo 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 userBCN 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 will notPAIN MANAGEMENT EPIDURAL STEROID INJECTIONS AUTHORIZATION REQUEST FORM Utilization management toll-free phone: 1-833-217-9670 Utilization management local phone: 313-908-6040

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 CarelonMusculoskeletal Services. Providers must obtain authorization from TurningPoint Healthcare Solutions LLC for: Orthopedic procedures. Pain management procedures. Spinal procedures. This requirement applies to BCN commercial and BCN Advantage SM members. For information about musculoskeletal services for Blue Cross commercial …

Blue Cross Blue Shield of Michigan Medicare Advantage Grievances and Appeals Department P.O. Box 2627 Detroit, MI 48231-2627 ... ereferrals.bcbsm.com : website: • Blue Cross Carelon-Managed Procedures • BCN Carelon-Managed Procedures You’ll also find information in the document titled :BCN Healthy Blue Choices POS. Healthy Blue Choices POS. Healthy Blue Choices SM POS is a point-of-service product for FCA non-bargaining employees and retirees that is administered by Blue Care Network. Healthy Blue Choices POS allows the flexibility to receive covered health care services in or out of network without a referral.©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.Blue Cross/BCN Provider Communications Created Date: 20221111145255Z ...On Oct. 15, 2023, Blue Cross Blue Shield of Michigan and Blue Care Network will update questionnaires in the e-referral system. We’ll also update the corresponding …ereferrals.bcbsm.com. 4. What if I have trouble completing the questionnaire within the e-referral system? If you're having trouble completing the questionnaire in the e-referral system, call Medicare Plus Blue at 1-888-803-4960. 5. Where can I find additional resources? The . Behavioral Health page. in the Blue Cross section ofBlue Cross Blue Shield of Michigan• 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 ®

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.

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.

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).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.Watch for news on system updates, training and other topics at ereferrals.bcbsm.com. *Blue Cross Blue Shield of Michigan doesn’t own or control this website. Availity® is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to offer provider portal and electronic data interchange services. W010723Blue Cross and BCN utilization management medical drug list for Blue Cross commercial and BCN commercial members. We'll update this list prior to the effective change of the change. You can access this list and other information about requesting prior authorization on the following pages of the ereferrals.bcbsm.com website:Click Maintain User under your account in the top navigation or My Account. Dashboard and locate the user's account. Click the name of the user. Click Revoke User. Select the organization (s) from which you want to revoke the user. If the user belongs to a single organization, that organization is selected by default.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 ...Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association. Clinical coding. You can access clinical coding specific to the procedures included in the program in the . Musculoskeletal procedure codes that require authorization by TurningPoint document.Skilled Nursing Facility and Acute Inpatient Rehabilitation form for Blue Cross and BCN commercial members. Michigan providers should attach the completed form to the …PAIN MANAGEMENT EPIDURAL STEROID INJECTIONS AUTHORIZATION REQUEST FORM Utilization management toll-free phone: 1-833-217-9670 Utilization management local phone: 313-908-6040eviCore is an independent company that manages authorizations of select services for Blue Cross Blue Shield of Michigan and Blue Care Network. Title: Blue Cross and BCN: Procedure codes that require authorization by eviCore healthcare Author: Blue Cross/BCN Provider CommunicationsA BCN-approved autism analysis evaluation center, or AAEC, participating with the member's health plan, must make or confirm a diagnosis of ASD for the member. Note: If the member has a concern about obtaining an AAEC evaluation, please call BCN Behavioral Health at 1-800-482-5982. The treatment plan prepared by the AAEC must include a ...

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 bcbsm.com 600 E. Lafayette Blvd., Detroit, MI 48226-2998 A nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association Customer Service: 800-XXX-XXXX To locate participating providers outside of Michigan: 800-810-2583 Misuse may result in prosecution.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? TheAccess this document via ereferrals.bcbsm.com to ensure you're viewing the most up-to-date information. Durable medical equipment and ... diabetes supplies (except shoes and inserts) for Blue Cross Blue Shield of Michigan and Blue Care Network members who have Northwood Inc. is an independent company that manages bothInstagram:https://instagram. katy weather radartide chart boothbay harborweather radar st augustine flcake disposable vape not hitting you 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 dateQuick 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 ... amy watson news channel 5myaccessflorida interview number 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 the cheapest gas in fort lauderdale For Blue Cross PPO (commercial) behavioral health requirements, see the For Blue Cross PPO (commercial) members section on ereferrals.bcbsm.com under Blue Cross then the Behavioral Health section. While this issue is being resolved, we are voiding these cases manually and sending a message to providers why the case has been voided. Posted: June ...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 theYes, BCN will be loading some of the information contained on the previous e-referral system into the new system. Cases beginning Jan. 1, 2013 will be loaded into the new system. This includes cases spanning Jan. 1, 2013 - meaning cases that were authorized to start prior to Jan. 1, 2013 and extend beyond Jan. 1, 2013.