Bcbs of michigan provider phone number for prior authorization

Bcbs of michigan provider phone number for prior authorization. Providers. Providers may request prior authorization for MESSA members by visiting the MESSA website. 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. 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. The areas that will be affected are: Area Requirements for services provided by non-Michigan providers may vary from those outlined in this document. Providers within Michigan. to 9 p. 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. Set up an account in the portal. 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. 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. 2. Contact your local Blue Plan for information on how to submit a prior authorization request. Care management and utilization management programs. Utilization management programs for Michigan providers. 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. 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. Blue Cross Blue Shield of Michigan and Blue Care Network require health care providers to obtain approval before providing certain services. November 1, 2016. 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. See full list on bcbsm. If more assistance is needed, your doctor can call PerformRx Pharmacy Provider Services at 1-888-989-0057. 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. 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. The steps required to determine whether prior authorization, including precertification, is We offer provider training. Clear Inputs. 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. Navigating health care can be overwhelming. Submitting a prior authorization request. Log in to our provider portal (availity. 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. E-referral system maintenance times and what to do. 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. 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. Prior authorization is required. 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. 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. 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. See the e-referral User Guide to learn how. 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. We provide health insurance in Michigan. Prior Authorization ©1996-2024 Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent Oct 21, 2016 · Program. Request a Clinical Certification to start the process. Type data into every field unless otherwise noted. Provider Programs; Prior Authorization Resources; About BCC; Leadership; Member Advisory Council; News; Careers; Contact Us; LOGIN. Authorization requests accepted. com. 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. com*). Prior authorization requests are reviewed by our independent pharmacy benefits manager. CONTACT INFORMATION. I need to contact. Lawrence, Tompkins Authorization Call Center Phone Numbers If you wish to contact Evolent (formerly National Imaging Associates, Inc. Provider portal training video; • Fax a completed Prior Authorization Form to: 512-380-7507. Prior Authorizations (also referred to as pre-approval, pre-authorization and pre-certification) can be submitted digitally via the authorizaton application in Availity Essentials. 3. m. Agents. For professional providers. Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. com or call Evolent at 1-800-424-5351 . COVERAGE AREA - CNY: Cayuga, Cortland, Jefferson, Lewis, Onondaga, Oswego, St. Blue Cross Blue Shield of Michigan doesn't directly handle credentialing for providers. 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. If you're within Michigan, you can use our e-Referral site to learn whether you need to submit a prior authorization. TTY users: To reach any number listed here, dial 711. ©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. 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. If you're practicing outside Michigan, use these documents to learn how to submit a prior authorization: PPO Prior Authorization Requirements (PDF) Prior authorization . Health care providers must submit prior authorization requests before providing services. Check each member’s eligibility and benefits prior to providing services. Jun 27, 2024 · Blue Cross Blue Shield of Michigan and Blue Care Network require prior authorization for certain benefits. If you are a provider in Michigan, contact Blue Cross Blue Shield through our association of doctors and hospitals, including Blue Care Network providers. 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. 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. • For medical oncology and supportive care drugs, you’ll submit prior authorization requests to Carelon Medical Benefits Management. 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. For more information, see the document titled . 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. Michigan prescribers . com . • If non-emergency air ambulance transport is needed, prior authorization is required. Type of request: Initial authorization Continued stay / extension of stay SNF / IPR information Federal Employees Health Benefits. To learn more, see our Training Tools page. Providers are encouraged to use resources below, visit RadMD. To access the manual: 1. for. 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. If For information about behavioral health services for dates of service before Jan. about. Click Payer Spaces on the menu bar and then click the BCBSM and BCN logo. If a prior authorization is required for your medical service, your doctor or health care professional must submit the prior authorization request. , for most non-emergency outpatient diagnostic imaging services. We’re here to make your job easier. Note: If this list specifies that you should submit a prior authorization request to Carelon but you’re prescribing the drug for a . 3 — Y0074_IGHCPCSPA_C FVNR 1223 i . Balloon ostial dilation . non-oncology diagnosis, don’t. 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. 3 Brian Fetterly (315) 731-9671 brian. Outpatient Radiation Therapy. Non-Michigan providers. ©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 information about submitting prior authorization requests, see the . ereferrals. Blue Cross Behavioral Health: Frequently asked questions for providers PDF. ) directly, please use the appropriate toll-free number for the respective health plan. Help your patients make the most of their healthcare dollar by prescribing generics rather than high-cost brand name drugs. 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. Contact For Providers: Contact us (bcbsm. Blue Cross Blue Shield of Michigan providers, submit prior authorization for your Medicare Plus Blue PPO and BCN Advantage patients' prescriptions. Blue Cross. 1, 2024 (PDF). 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. bcbsm. submit the request to Carelon. To submit a mandatory prior authorization, follow the steps below: Register. 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. Non-Michigan providers: BCN prior authorization requirements in the BCN section of . 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. fetterly@excellus. Enter N/A if not applicable. Some medicines and benefits require prior authorization by Blue Cross Complete. Determine prior authorization requirements for members. We offer provider training. Determining prior authorization requirements for members For Michigan and non -Michigan providers Revised July 3, 2024 1 . Submitting requests for inpatient admissions on holidays. Use the e-referral system to submit the request. Find the right contact. Do this prior to the flight. 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. Blue Cross Blue Shield of Michigan providers, find pharmacy resources such as prior authorization forms, drug lists and more. 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. Medical Services Out-of-State & Non-Network Providers. 2024. Please Select Your State The resources on this page are specific to your state. Providers outside Michigan. com). 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. 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. 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. 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. This means we need to review a service to be sure it is medically necessary and appropriate. In the eviCore portal, select . com Effective May 1, 2022, Blue Cross Complete will require prior authorization from Evolent, formerly National Imaging Associates, Inc. Select the prior authorization program for which you’re submitting a prior authorization request. Beginning dates of service. Prior Authorization ©1996-2024 Blue Cross Providers. For those providers, all services require prior authorization except for emergency room and urgent care visits. 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. 1, 2024, see Behavioral health information for dates of service before Jan. 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. rtw gxlq eyez ygldsq jxqkm pyvcnx vdg pzxo dds ollol  »