Bcbs of michigan provider phone number for prior authorization

Bcbs of michigan provider phone number for prior authorization. Log in to our provider portal (availity. Navigating health care can be overwhelming. If it doesn't work, or your doctor doesn’t think they’re appropriate for you, they can submit a prior authorization request for a non-formulary medicine. Prior Authorization ©1996-2024 Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent Oct 21, 2016 · Program. For some procedures or services, providers must submit clinical Blue Cross Blue Shield of Michigan requires prior authorization for certain procedures to ensure that members get the right care at the right time and in the right location. Blue Cross Blue Shield of Michigan providers, submit prior authorization for your Medicare Plus Blue PPO and BCN Advantage patients' prescriptions. Check each member’s eligibility and benefits prior to providing services. If For information about behavioral health services for dates of service before Jan. Outpatient Radiation Therapy. If more assistance is needed, your doctor can call PerformRx Pharmacy Provider Services at 1-888-989-0057. Clear Inputs. October 21, 2016 Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross Blue Shield Association. Blue Cross. I need to contact. Note: If this list specifies that you should submit a prior authorization request to Carelon but you’re prescribing the drug for a . If you're within Michigan, you can use our e-Referral site to learn whether you need to submit a prior authorization. Contact For Providers: Contact us (bcbsm. ) directly, please use the appropriate toll-free number for the respective health plan. This means we need to review a service to be sure it is medically necessary and appropriate. To submit prior authorization requests electronically, first register for Availity ® Essentials, our provider portal; refer to the ©1996-2024 Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross Blue Shield Association. Prior authorization requests are reviewed by our independent pharmacy benefits manager. Prior authorization is required. Submit a prior authorization request using one of the following forms: Medication prior authorization request form (PDF) To submit prior authorization requests electronically, please submit an electronic Prior Authorization through your Electronic Health Record tool Follow these steps to submit prior authorization requests when prescribing drugs covered under the medical benefit for Blue Cross Blue Shield of Michigan and Blue Care Network commercial members. To request prior authorization, follow the instructions on the document titled Non-emergency air ambulance prior authorization program: Overview for Michigan and non-Michigan providers. com. m. Non-Michigan providers: BCN prior authorization requirements in the BCN section of . Provider Programs; Prior Authorization Resources; About BCC; Leadership; Member Advisory Council; News; Careers; Contact Us; LOGIN. To submit prior authorization requests electronically, first register for Availity ® Essentials, our provider portal; refer to the Availity ® Essentials is Blue Cross Blue Shield of Michigan and Blue Care Network’s provider portal. to 9 p. See full list on bcbsm. Jun 27, 2024 · Blue Cross Blue Shield of Michigan and Blue Care Network require prior authorization for certain benefits. 3 — Y0074_IGHCPCSPA_C FVNR 1223 i . Use the e-referral system to submit the request. For professional providers. 1, 2024 (PDF). non-oncology diagnosis, don’t. fetterly@excellus. If you're practicing outside Michigan, use these documents to learn how to submit a prior authorization: PPO Prior Authorization Requirements (PDF) Prior authorization . For more information, see the document titled . Blue Cross Blue Shield of Michigan providers, find pharmacy resources such as prior authorization forms, drug lists and more. com*). Request a Clinical Certification to start the process. In the eviCore portal, select . To simplify your experience with prior authorization and save time, please submit your prior authorization request to the pharmacy benefits manager through any of the following online portals: CoverMyMeds Did you know? Michigan's prior authorization law* requires health care providers to submit prior authorization requests electronically for commercial members. Providers outside Michigan. bcbsm. com). Ascension Personalized Care Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association. If you need help choosing a plan, you can talk to one of our health plan advisors by calling: 1-888-563-3307 TTY users: 711 8 a. If you’re experiencing temporary technical problems, such as a power system or internet outage, you can submit Michigan’s prior authorization law* requires health care providers to submit prior authorization requests electronically for commercial members. Blue Cross Blue Shield of Michigan doesn't directly handle credentialing for providers. November 1, 2016. If you are a provider in Michigan, contact Blue Cross Blue Shield through our association of doctors and hospitals, including Blue Care Network providers. Blue Cross Blue Shield of Michigan and Blue Care Network require health care providers to obtain approval before providing certain services. 3 Brian Fetterly (315) 731-9671 brian. Care management and utilization management programs. As a PPO/POS, HMO or Traditional contracted provider with Blue Cross and Blue Shield of Texas, you are responsible for the completion of the prior authorization process for BlueCard members. Utilization management programs for Michigan providers. Providers within Michigan. Type of request: Initial authorization Continued stay / extension of stay SNF / IPR information Federal Employees Health Benefits. Help your patients make the most of their healthcare dollar by prescribing generics rather than high-cost brand name drugs. See the e-referral User Guide to learn how. Balloon ostial dilation . ereferrals. Authorization requests accepted. CONTACT INFORMATION. Lawrence, Tompkins Authorization Call Center Phone Numbers If you wish to contact Evolent (formerly National Imaging Associates, Inc. Medical Services Out-of-State & Non-Network Providers. submit the request to Carelon. com . Beginning dates of service. Agents. TurningPoint Healthcare Solutions LLC is an independent company that manages prior authorizations for musculoskeletal surgical and related procedures for Blue Cross Blue Shield of Michigan and Blue Care Network. To access the manual: 1. Submitting a prior authorization request. The steps required to determine whether prior authorization, including precertification, is We offer provider training. TTY users: To reach any number listed here, dial 711. Providers may request prior authorization for MESSA members by visiting the MESSA website. Type data into every field unless otherwise noted. Providers are encouraged to use resources below, visit RadMD. We’re here to make your job easier. See the document titled These sites are maintained by organizations over which Blue Cross Complete of Michigan exercises no control, and Blue Cross Complete of Michigan expressly disclaims any responsibility for the content, the accuracy of the information and/or quality of products or services provided by or advertised on these third-party sites. We're always available to answer questions and to help you and your employees get the most out of your Blue Cross Blue Shield health plan benefits. To submit a mandatory prior authorization, follow the steps below: Register. Determining prior authorization requirements for members For Michigan and non -Michigan providers Revised July 3, 2024 1 . • If non-emergency air ambulance transport is needed, prior authorization is required. 2024. com or call Evolent at 1-800-424-5351 . Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. Alternate submission methods (fax or phone) are Some medical services and medications may need a prior authorization (PA), sometimes called a “pre-authorization,” before care or medication can be covered as a benefit. Do this prior to the flight. For general inquiries and questions about the Service Benefit Plan, our overseas and pharmacy coverage or fraud assistance, you can call us toll-free nationwide. com Effective May 1, 2022, Blue Cross Complete will require prior authorization from Evolent, formerly National Imaging Associates, Inc. Click Payer Spaces on the menu bar and then click the BCBSM and BCN logo. Contact your local Blue Plan for information on how to submit a prior authorization request. Mandatory Prior Authorization As a result of the Michigan prior authorization legislation (referred to as Public Act 60), health care providers must electronically submit prior authorization (PA) requests. Through the site, you can: Check member eligibility and benefits; Check claim status; View remittance advice and vouchers; Determine if a prior authorization or referral is required and link to the appropriate application to submit the request Mar 1, 2023 · to insurers and providers in Michigan for members who have commercial coverag. Blue Cross Complete of • Non-Michigan providers who aren’t contracted with their local Blue Cross Blue Shield plan are considered by Blue Care Network (the HMO subsidiary of Blue Cross Blue Shield of Michigan) to be noncontracted. Prior Authorization ©1996-2024 Blue Cross Providers. The areas that will be affected are: Area Requirements for services provided by non-Michigan providers may vary from those outlined in this document. For those providers, all services require prior authorization except for emergency room and urgent care visits. For information about submitting prior authorization requests, see the . How to Determine Requirements: Telephone: Call the BlueCard Eligibility line at 1-800-676-2583 and ask to be transferred to the Medical Management Department. Important: 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. Alternate submission methods are allowed in the case of temporary technological problems, such as power or internet outages; see the information about submitting prior authorization requests through By Phone: Call the number on the back of the member’s ID card or dial 800-676-BLUE (2583) to speak to a Provider Service representative. Prior Authorization ©1996-2024 Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent Blue Cross Blue Shield of Michigan’s Medicare Plus BlueSM PPO Provider Manual Revised January 1, 2022. Provider portal training video; • Fax a completed Prior Authorization Form to: 512-380-7507. Health care providers must submit prior authorization requests before providing services. Blue Cross Blue Shield of Michigan requires prior authorization for certain procedures to ensure that members get the right care at the right time and in the right location. Providers. for. How do I submit prior authorization requests to TurningPoint? Submit prior authorization requests to TurningPoint as follows: • For commercial members, Michigan’s prior authorization law** requires health care providers to submit prior authorization requests electronically. Alternate submission methods are allowed in the case of temporary technological problems, such as power or internet outages; see the information about submitting prior authorization requests through Follow these steps to submit prior authorization requests when prescribing drugs covered under the medical benefit for Blue Cross Blue Shield of Michigan and Blue Care Network commercial members. Select the prior authorization program for which you’re submitting a prior authorization request. Please Select Your State Important: 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. Alternate submission methods are allowed in the case of temporary technological problems, such as power or internet outages; see the information about submitting prior authorization requests through alternate methods below. Blue Cross Blue Shield of Michigan and Blue Care Network are changing how we approach coverage of glucagon-like peptide-1 receptor agonist , known as GLP-1, drugs indicated for weight loss for our fully insured large group commercial members. 3. Find the right contact. e These requirements aim to give members and health care providers a clearer understanding of the services that require prior authorization and of the prior authorization criteria for medical and pharmacy benefits. Submitting requests for inpatient admissions on holidays. We provide health insurance in Michigan. The steps required to determine whether prior authorization, including precertification, is Apr 23, 2020 · United States List BCBS Provider Phone Number; Alabama: 800-517-6425 (Benefits/Eligibility) 800-327-3994 (PEEHIP) 800-760-6851 (Customer Service) 800-492-8872 (Federal Employee Program) Learn how to contact your local Blue Cross and Blue Shield company, as well as other key areas. ©1996-2024 Blue Cross Blue Shield ©1996-2024 Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross Blue Shield Association. • For medical oncology and supportive care drugs, you’ll submit prior authorization requests to Carelon Medical Benefits Management. Prior authorization and pharmacy programs listed in this guideline: • BCN Custom Drug List • BCBSM Custom Drug List • BCBSM Clinical Drug List • BCN Custom Select Drug List Michigan’s prior authorization law* requires health care providers to submit prior authorization requests electronically for commercial members. about. Ask your provider to go to Prior Authorization Requests to get forms and information on services that may need approval before they prescribe a specific medicine, medical Jun 6, 2024 · cover GLP-1 drugs for weight loss may continue using their current prior authorization criteria. Please Select Your State The resources on this page are specific to your state. Prior Authorizations (also referred to as pre-approval, pre-authorization and pre-certification) can be submitted digitally via the authorizaton application in Availity Essentials. 1, 2024, see Behavioral health information for dates of service before Jan. This tool will guide you through the steps performed in submitting authorization requests for Home Health services for Blue Cross Blue Shield of Michigan, using the CareCentrix HomeBridge Portal: Requesting an Initial or Prior Authorization; Requesting a Reauthorization or Continuation of Services; Editing an Authorization Blue Cross Behavioral HealthSM manages prior authorizations. Set up an account in the portal. Non-Michigan providers. ©1996-2024 Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross Blue Shield Association. E-referral system maintenance times and what to do. eviCore healthcare ® is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to manage prior authorizations for select services. Some medicines and benefits require prior authorization by Blue Cross Complete. If a prior authorization is required for your medical service, your doctor or health care professional must submit the prior authorization request. ET Monday through Friday Blue Cross commercial provider resources You can find additional information about Blue Cross provider resources in the Blue Pages Directory chapter of the Blue Cross Commercial Provider Manual. Non-Michigan providers who treat Medicare Advantage members who travel or live outside of Michigan should review the following documents: For Medicare Plus Blue members: Medicare Plus Blue PPO Fact Sheet (PDF) For BCN Advantage members: Non-Michigan providers: BCN prior authorization requirements (PDF) Procedure codes for which providers must request prior authorization For Blue Cross commercial, Medicare Plus BlueSM, BCN commercial and BCN AdvantageSM v. COVERAGE AREA - CNY: Cayuga, Cortland, Jefferson, Lewis, Onondaga, Oswego, St. 2. We offer provider training. Blue Cross Behavioral Health: Frequently asked questions for providers PDF. If you’re experiencing temporary technical problems, such as a power system or internet outage, you can submit eviCore for Blue Cross and BCN document to learn how non-Michigan providers can access the eviCore provider portal. To learn more, see our Training Tools page. Enter N/A if not applicable. Michigan prescribers . Determine prior authorization requirements for members. , for most non-emergency outpatient diagnostic imaging services. neea tian brofk tpjfh djhl kdxrdm xiic ktgfvk zxdd tgdr