Blue Cross and BCN behavioral health changes coming Jan. 1

Starting Jan. 1, 2024, Blue Cross Blue Shield of Michigan and Blue Care Network will consolidate the prior authorization and case management functions for behavioral health services, including treatment for autism. This change will affect all members:

• Blue Cross commercial
• Medicare Plus Blue℠
• BCN commercial
• BCN Advantage℠

The consolidation will result in two new programs that will align and standardize prior authorization and case management functions for all lines of business. This will make it easier for you to manage administrative functions for your Blue Cross and BCN patients. As part of this change, Lucet (New Directions) will no longer manage these functions for Blue Cross commercial members.

What are the names of the new programs?

The new programs are:

• Blue Cross Behavioral Health℠, which will manage prior authorizations for behavioral health services, including treatment for autism
• Blue Cross^® Coordinated Care℠, which will handle behavioral health care management

What changes will providers and members see?

Here are some changes to expect:

• Providers will submit prior authorization requests through our provider portal (availity.com).**
• We’ll no longer require routine faxing or electronic submission of discharge summaries.
• Providers and members may notice some changes in notification letters, such as those sent when prior authorization requests are approved or denied.
• Members currently enrolled in behavioral health case management services may be assigned a new case manager in January. The members affected by this change will be notified.

There will be no changes to:

• Provider networks
• Provider reimbursement
• Members’ coinsurance, copayments or deductibles
• The phone numbers that providers and members use to contact Blue Cross regarding prior authorization or case management. Voice prompts will direct callers to make one of the following selections:
• For services prior to Jan. 1, 2024
• For services after Dec. 31, 2023

What’s changing for prior authorization requests?

For autism treatment services: Because prior authorizations for autism treatment services are typically approved for a longer period of time than for other services, we began handling them differently, starting in July, to ensure we can transition them into the new system.

• As of July 2023: Prior authorizations for autism treatment services are being approved for shortened times — that is, for less than the typical six-month time period.

Starting in November:

• Blue Cross Behavioral Health will manually enter cases into the new system.
• Each “new” case will be created with a “start” or “admission” date of Jan. 1, 2024. Providers must include the new date in claims submissions for services provided in 2024.
• Providers and members will receive letters that will reflect authorizations for the remainder of the typical six-month period that was shortened due to the transition to the new system.

Starting in 2024:

• Providers should request their next authorization or concurrent review based on the end date cited in the authorization letter they received in November or December.  

Note: For BCN commercial members, providers will continue to submit authorization requests and information updates for autism treatment services through our provider portal (availity.com).** Faxes won’t be accepted.

For services other than autism treatment:

• For some services that require prior authorization and that will continue into 2024, providers will need to obtain a new prior authorization. These prior authorizations will have a new “start/admission date,” which providers must include in claims submissions for services provided in 2024. This applies to:
• Partial hospitalization program services for Blue Cross commercial and Medicare Plus Blue members
• Transcranial magnetic stimulation, or TMS, services for Blue Cross commercial members
• For other services that require prior authorization and that have start dates or dates of service before Jan. 1, 2024, providers should submit requests for prior authorization and reviews of continued stays using the same processes they’re currently using. 
• For intensive outpatient services for Medicare Plus Blue, BCN commercial and BCN Advantage members, prior authorization won’t be required starting Jan. 1, 2024.
• For neurofeedback services for BCN commercial and BCN Advantage members, prior authorization won’t be required starting Jan. 1, 2024.

Additional information

Look for more information about these and other changes in upcoming newsletter articles.

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.

**Blue Cross Blue Shield of Michigan and Blue Care Network don’t own or control this website.