Utilization management programs summary now available

Do you ever get confused as to which products require authorization? We’ve put together a handy document that helps you find out whether a service you’re providing requires an authorization and how to get it.

The document for Michigan providers includes all lines of business for Blue Cross Blue Shield of Michigan and Blue Care Network and lists who manages the authorizations. It will be updated from time to time.

The utilization management programs summary document has been posted online at these locations –

On ereferrals.bcbsm.com -

The BCN Authorization Requirements & Criteria page
The Blue Cross Authorization Requirements & Criteria page in both the Blue Cross PPO and Medicare Plus Blue PPO sections

On the Blue Cross Clinical Criteria & Resources page within Provider Secured Services

The document is not an all-inclusive list of procedures and services that require authorization, but we hope it’s a way to help you keep straight the requirements for some of the most frequently performed services. MESSA is excluded from all eviCore healthcare authorization programs.

No portion of this publication may be copied without the express written permission of Blue Cross Blue Shield of Michigan, except that BCBSM participating health care providers may make copies for their personal use. In no event may any portion of this publication be copied or reprinted and used for commercial purposes by any party other than BCBSM.

*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2017 American Medical Association. All rights reserved.