Ereferrals.bcbsm

Blue Cross/BCN Provider Communications Created Date: 20221111145255Z ...

e-Referral - News Item. For dates of service on or after Oct. 1, 2018, AIM Specialty Health will manage the authorization process for cardiology and high-tech radiology procedures for BCN HMO SM (commercial) and BCN Advantage SM members. We first communicated about this in the article AIM Specialty Health to manage cardiology and high-tech ...BCN Provider Resource Guide - e-Referral - Home. BCN Provider Resource Guide Behavioral Health Welcome to the BCN Provider Resource Guide!Benefits and Eligibility In this Guide you will find contact information for many of the services that BCN offers Care Management and for the functions you most frequently perform in servicing BCN members. Chronic Condition Use the navigation bar at the left ...ereferrals.bcbsm.com. website. eviCore healthcare is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to manage authorizations for select services. For more information, go to our . ereferrals.bcbsm.com. website.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 theBlue 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 risksBlue Cross Blue Shield of Michigan and Blue Care Network provide a variety of training opportunities to learn about the e-referral system. For information about signing up to use the e-referral system, refer to the Sign up for e-referral or change a user webpage.. We offer the following training resources for the e-referral system:. User guides and documentation

Access this document via ereferrals.bcbsm.com to ensure you're viewing the most up-to-date information. Outpatient PT, OT and ST, and physical medicine ... eviCore healthcare is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to manage authorizations for select services. For more information ...Click Secure Provider Resources (Blue Cross and BCN) on the Resources tab. Click Coronavirus on the Member Care tab. This page provides Blue Cross Blue Shield of Michigan's prior authorization requirements, including information that applies to: Blue Cross commercial and Medicare Plus Blue. Blue Cross commercial only. Blue Care Network commercial and BCN Advantage. SM. Clinical review is required for adult members (age ≥18). The medical necessity criteria are outlined below. CPT codes: *93653, *93654 and *93656. Atrial fibrillation (AF) by ECG . One of the following must be met: 1. Paroxysmal atrial fibrillation and ALL: a. Must have one of the following ...Carelon Medical Benefits Management is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to manage authorizations for select services. For more information, go to our . ereferrals.bcbsm.com website.Starting July 1, 2023, Blue Cross Blue Shield of Michigan and Blue Care Network will request that providers submit clinical outcomes using the Audaire Health provider portal following approval of prior authorization requests and administration of chimeric antigen receptor T-cell (CAR-T) therapy for Blue Cross and BCN commercial members.November 2022. Xenpozyme TM and Spevigo ® to have site-of-care requirements for most commercial members starting March 1 (PDF) New and updated questionnaires in the e-referral system starting Nov. 27 (PDF) Outpatient ECT won't require prior authorization for BCN members, starting Jan. 1 (PDF) Nov. 24-25 holiday closure: How to submit ...

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.medical benefit for BCN HMO and BCN Advantage members. Complete this form and fax it to BCN at 1-800-675-7278 along with supporting clinical documentation. Please contact BCN Care Management at 1-800-392-2512 with any questions. **Required for ALL requests** Drug information. ALL REQUESTED INFORMATION MUST BE PROVIDED FOR CONSIDERATION FOR ...This document describes the referral and plan notification requirements that apply to Blue Cross Blue Shield of Michigan and Blue Care Network members. It also summarizes the types of procedures and services that require authorization for Blue Cross Blue Shield of Michigan and BCN members and indicates which entity manages the authorizations.Carelon-Managed Procedures (formerly AIM) Providers must obtain authorization from Carelon Medical Benefits Management (formerly AIM Specialty Health ®) for the following services: Cardiology services - Medicare Plus Blue SM. This includes cardiac implantable devices and services. High-tech radiology - This includes procedures for Michigan ...Click Secure Provider Resources (Blue Cross and BCN) on the Resources tab. Click Coronavirus on the Member Care tab. This page provides Blue Cross Blue Shield of Michigan's prior authorization requirements, including information that applies to: Blue Cross commercial and Medicare Plus Blue. Blue Cross commercial only.is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to offer provider portal services. Confidentiality notice: This transmission contains confidential inform ation belonging to the sender that is legally privileged. This information is intended only for use of the individual or entity named above.

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• See the BCN referral and authorization requirements for Michigan providers document. • See the "Authorization criteria and preview questionnaires" section of the BCN Authorization Requirements & Criteria page on our ereferrals.bcbsm.com website. • See the Utilization Management chapter of the BCN Provider Manual.Carelon Medical Benefits Management is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to manage prior authorizations for select services. For more information, go to our . ereferrals.bcbsm.com website.BCN HMO SM (commercial) BCN Advantage SM; The updated authorization criteria and preview questionnaires are available at ereferrals.bcbsm.com. To find them, click BCN, then click Authorization Requirements & Criteria. Next, look in the "Authorization criteria and preview questionnaires" section.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 to inquire.• 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 ®

ATTN: BCN Advantage Grievances and Appeals Unit . P.O. Box 284 . Southfield MI 48076-5043 . Fax: 1-866-522-7345 . Phone: 1-800-450-3680 . BCN will process these appeals using the normal BCN Advantage appeal processes for standard and expedited appeals.Online provider search — bcbsm.com has an online provider search that allows you to look for affiliated providers by first selecting the member's Blue Cross or BCN product and then viewing the network choices by type of care and location. More detailed searches are possible by clicking on More Search Options. Once you have located the ...To access the forms: 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 Resources tab. Click Secure Provider Resources (Blue Cross and BCN). Click the Forms menu and make the appropriate selection. BCN AdvantageSM. Skilled nursing facilities and home health ...ereferrals.bcbsm.com. They show the questions you'll need to answer in the e-referral system so you can prepare your answers ahead of time. To find the preview questionnaires, click BCN and then click . Authorization Requirements & Criteria. Scroll down and look under the "Authorization criteria and preview questionnaires" heading.Login | Register | My online account | bcbsm.comTo 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).Access this document via ereferrals.bcbsm.com to ensure you're viewing the most up-to-date information. Laboratory For genetic testing and molecular testing ... is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to offer provider portal and© 1996-Blue Cross Blue Shield of Michigan and Blue Care Network Nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association.Blue ...

For BCN: 1-844-377-1278 For services that do not have approved authorizations, claims may be denied and providers may not bill the member. Where to find additional information For information about finding clinical guidelines and submitting prior authorization requests, refer to these webpages on the ereferrals.bcbsm.com website :

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.Blue Cross/BCN Provider Communications Created Date: 20221102132219Z ...providers please contact [email protected] or 800-437-3803 and ask for Kristy S. for further assistance) 2. After 10 days: Go to Ereferrals.bcbsm.com select Login (green button); you will be re-directed to Provider Secured Services. 3. On the Provider Secured Services screen look for the following link:BCN Care Management provider call volumes high. BCN Care Management is experiencing high call volumes. To avoid waiting on the phone line, providers should use BCN's e-referral system to submit or check the status of referrals or requests for clinical review.We encourage providers to call the Medical Information Specialist line at 1-800-392-2512 with urgent requests only.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 …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.Blue Cross Blue Shield of Michigan and Blue Care Network provide a variety of training opportunities to learn about the e-referral system. For information about signing up to use the e-referral system, refer to the Sign up for e-referral or change a user webpage.. We offer the following training resources for the e-referral system:. User guides and documentation

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View everything Blue Cross Blue Shield of Michigan and Blue Care Network pharmacy related. Access pharmacy resources. Downloadable resources. These documents and materials can help you explain tough topics to your patients. TOOLKIT. Good Health Club. Help encourage children and young adults to be healthy.Carelon Medical Benefits Management is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to manage authorizations for select services. For more information, go to our . ereferrals.bcbsm.com website.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 CarelonBlue Cross Blue Shield of MichiganImportant: For Blue Cross Blue Shield of Michigan commercial and Blue Care Network commercial members, Michigan’s prior authorization law* requires health care providers to submit prior authorization requests electronically. If you’re experiencing temporary technical problems, such as a power system or internet outage, you can submit ...U-M Premier Care Therapy Diagnosis Codes ICD-9 …ereferrals.bcbsm.com ...Access 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 bothBCN 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 notElect Plus POS, refer to BCN's Blue Elect Plus POS webpage on the ereferrals.bcbsm.com website. Blue Elect Plus POS is available Jan. 1, 2021. Note: As a rule, physicians must follow the authorization requirements that apply to the region in which the headquarters for their medical care group is located. For BCN commercial, call 1-800-482-5982. For BCN Advantage, call 1-800-431-1059. Additional information. As a reminder, you can access resources related to authorizations and referrals on our ereferrals.bcbsm.com website. Click either Blue Cross or BCN and then use the links in the left navigation to reach information related to specific services.webpage at ereferrals.bcbsm.com Note: If any of the information presented here conflicts with the provider contract, the contract language should be followed. *Clicking this link means that you're leaving the Blue Cross Blue Shield of Michigan and Blue Care Network website. ….

Click BCN Medical Benefit - Prior Authorization on the Provider Secured Services welcome page. Enter your NPI. This will bring you to the NovoLogix welcome page. BCN's Pharmacy Help Desk. BCN's Pharmacy Help Desk can also input the request on your behalf. You can call the Help Desk at 1-800-437-3803.Click BCN Medical Benefit - Prior Authorization on the Provider Secured Services welcome page. Enter your NPI. This will bring you to the NovoLogix welcome page. BCN's Pharmacy Help Desk. BCN's Pharmacy Help Desk can also input the request on your behalf. You can call the Help Desk at 1-800-437-3803.providers please contact [email protected] or 800-437-3803 and ask for Kristy S. for further assistance) 2. After 10 days: Go to Ereferrals.bcbsm.com select Login (green button); you will be re-directed to Provider Secured Services. 3. On the Provider Secured Services screen look for the following link: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.Access this document via ereferrals.bcbsm.com to ensure you're viewing the most up-to-date information. Post-acute care For skilled nursing, rehabilitation and long-term acute care ... Blue Cross Blue Shield of Michigan and Blue Care Network members who have Medicare Advantage plans. Title: Post-acute care: For skilled nursing, rehabilitation ...To find the preview questionnaires, go to ereferrals.bcbsm.com, click BCN and then click . Authorization Requirements & Criteria. Scroll down and look under the "Authorization criteria and preview questionnaires" heading. Authorization criteria and medical policies The pertinent authorization criteria and medical policies are also available ...Blue Cross Blue Shield of Michigan and Blue Care Network offer care management programs 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. • Care management programs provide patient support by identifying ...Blue Cross/BCN Provider Communications Created Date: 20221111145255Z ... BCN Provider Manual. Look in the section titled “Authorization for behavioral health services.” • For Blue Cross commercial and Medicare Plus Blue members, refer to the Behavioral Health webpagen the Blue Cross section of the ereferrals.bcbsm.com website. In additioni , refer to: o Medicare Plus Blue PPO Provider Manual o Ereferrals.bcbsm, [text-1-1], [text-1-1], [text-1-1], [text-1-1], [text-1-1], [text-1-1], [text-1-1], [text-1-1], [text-1-1], [text-1-1], [text-1-1], [text-1-1], [text-1-1], [text-1-1], [text-1-1], [text-1-1], [text-1-1], [text-1-1], [text-1-1], [text-1-1], [text-1-1], [text-1-1], [text-1-1], [text-1-1], [text-1-1], [text-1-1], [text-1-1], [text-1-1], [text-1-1], [text-1-1], [text-1-1], [text-1-1], [text-1-1]