The Record - for physicians and other health care providers to share with their office staffs Forward to a friend  |  Subscribe  |  The Record Archive  |  Contacts  |  bcbsm.com  |  Print this article
September 2015

Treatment at freestanding substance abuse facilities will require authorization in 2016

Authorization for treatment at freestanding substance abuse residential facilities will be required for Blue Cross Blue Shield of Michigan commercial PPO members, beginning in 2016. New Directions LLC will perform the authorizations.

This requirement will only apply to the substance abuse residential level of care, not outpatient. The current authorization requirements for residential treatment at hospital-based substance abuse facilities remain the same.

Also note that accounts that have behavioral health currently managed by a vendor other than New Directions will not be affected by this change. This includes, but is not limited to, the State of Michigan group account, auto groups, UAW retirees and DENSO.

Admission authorization requests from freestanding substance abuse facilities will be made in accordance with New Directions medical necessity criteria, using the New Directions WebPass application. WebPass is a secure Internet portal that enables providers to document and submit clinical information online to New Directions for initial authorizations and continued stay reviews. The New Directions medical necessity criteria can be found here, and a demonstration of WebPass is available here.

More information regarding the authorization process, training and registration for WebPass, and the transition date will be made available prior to January 2016 in The Record and in future web-DENIS Alerts.

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 2014 American Medical Association. All rights reserved.
Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and
independent licensees of the Blue Cross and Blue Shield Association.