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Medicare Plus Blue 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 Medicare Plus Blue Behavioral Health at 1-888-803-4960.Go to ereferrals.bcbsm.com. 2. Click . Blue Cross. 3. Click Medical Benefit Drugs. 4. Scroll to the Blue Cross commercial column. ... *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. Title:and BCN Advantage. SM. members. • See also the 2022 Blue Cross and BCN Local Rules for acute care (modifications of InterQual acute care criteria) for admissions on or after March 1, 2022. 2022 Blue Cross and BCN modifications of InterQual skilled nursing facility criteria • A Blue Cross or BCN medical director reviews all requests for the ...

— This document is a supplement to the BCN Referral / Clinical Review Program. — 2 BCN Clinical Review Medical Necessity Criteria / Benefit Review Requirements / UPD OCT 2016 Requested service Required clinical criteria and information Note: Refer to the BCN Referral / Clinical Review Program for referral and review requirements. Biofeedbacke-Referral - News Item. For dates of service on or after Oct. 1, 2018, Trogarzo and Zilretta will be added to the medical drug prior authorization program for Blue Cross PPO (commercial) and BCN HMO SM (commercial) members. Trogarzo will also be subject to a site-of-care requirement for BCN HMO (commercial) members only, effective Oct. 1, 2018.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 …case pends and BCN cannot authorize it, BCN will contact the provider for additional clinical information. Procedure CPT codes* CT of the abdomen or CT of the abdomen and pelvis 74150, 74160, 74170, 74176, 74177, 74178 . CT of the brain 70450, 70460, 70470

medicine services for BCN members delivered by chiropractors. eviCore is an independent company that does not provide Blue Cross or Blue Shield products or services and that is solely responsible for the products or services it provides. 3 and at least one passive range of motion measurement, even if that measurement is within ...Through our provider portal: Log in to our provider portal ( availity.com *). Click Payer Spaces on the menu bar and then click the BCBSM and BCN logo. Click the eviCore Provider Portal tile on the Applications tab. By logging in directly to the eviCore provider portal at evicore.com *. You can also call eviCore at 1-855-774-1317. ….

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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 prior authorization requests. New questionnaire . We'll add the following questionnaire to the e-referral system: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 Carelon 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).. To sign up as a new e-referral user

Carelon-Managed Procedures (formerly AIM) Providers must obtain prior authorization from Carelon Medical Benefits Management (formerly known as AIM Specialty Health ®) for: In-lab sleep studies for BCN commercial members — For dates of service on or after Sept. 1, 2023. Select cardiology and radiology services for BCN commercial and BCN ...Here's what's changing for global referrals submitted for BCN HMO (commercial) members on or after March 13, 2020: For referrals with end dates in 2020, the end date will automatically be extended to Dec. 31, 2020. For referrals with end dates after Dec. 31, 2020, the end date specified in the e-referral system will apply. This applies to ...Blue Cross/BCN Provider Communications Created Date: 20221027184301Z ...

gsu microsoft office April 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 ... why doesn't west elm have reviewsdent in thigh When submitting requests before Sept. 24, 2021. Prior to Sept. 24, 2021, fax your request for preservice review as follows. For Blue Cross commercial members: Fax to Provider Inquiry at 1 866 311 9603. For BCN commercial members: Fax to the Medical Drug Help Desk at 1 877 325 5979.To access the list of Services That Require Authorization, visit ereferrals.bcbsm.com and click Blue Cross. Then click Authorization Requirements & Criteria on the left navigation bar. December 2017 . Blue Dot changes to the Blue Cross Medicare Plus Blue Service / Topic Vanous modern period piece crossword Nov 9, 2022 · 2. Click Payer Spaces on the menu bar and then click the BCBSM and BCN logo. 3. Click the Resources tab. 4. Click Secure Provider Resources (Blue Cross and BCN). Information for out-of-state providers See the following documents for referral and authorization requirements. • For Blue Cross commercial and Medicare Plus Blue members: jfk terminal 7 restaurantsbarndominium for sale georgiahex pentimento Access this document via ereferrals.bcbsm.com to ensure you're viewing the most up-to-date information. Advance care planning ... management services for Blue Cross Blue Shield of Michigan and Blue Care Network members who have Medicare Advantage plans. Title: Blue Cross and BCN - Advance care planning: For end-of-life decision making and ...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) portal chamber osrs We'll also make these lists available at ereferrals.bcbsm.com: On the Blue Cross Medical Benefit Drugs page; On the BCN Medical Benefit Drugs page; You'll also be able to find these lists behind the provider portal. We appreciate the feedback we received from the provider community and encourage additional comments on the new documents. athleta wellpro66f to centigradejet ski rentals cocoa beach JOINT AND SPINE PROCEDURES AUTHORIZATION REQUEST FORM Utilization management toll-free phone: 1-833-217-9670 Utilization management local phone: 313-908-6040