understanding bcbs michigan prior authorization and referrals

Prior authorization and referrals can be a complex and frustrating process, especially when dealing with a large health insurance company like BCBS Michigan.

BCBS Michigan requires prior authorization for certain medical services and treatments to ensure that they are medically necessary and meet certain criteria.

If you're planning to undergo a treatment or procedure that requires prior authorization, you'll need to submit a request to BCBS Michigan, which will then review the request to determine whether it meets the necessary criteria.

The prior authorization process typically takes 24 to 48 hours, but in some cases, it may take up to 14 days.

On a similar theme: Prior Authorization Process Flow Chart

The authorization process for BCBS Michigan can be a bit complex, but don't worry, I've got the lowdown.

To start, you'll need to know what services require authorization. For Medicare Plus Blue members, you can find this information in the Services That Require Authorization list, which is available in PDF format.

If this caught your attention, see: Does Bcbs Require Prior Authorization

Health care providers must submit both prior authorization requests and plan notifications before providing services. This applies to a wide range of services, including Acute Inpatient Admissions, Air Ambulance, and Autism, among others.

Here are some specific services that require prior authorization and plan notification:

It's worth noting that the plan notification requirements vary by region. In the East and Southeast regions, providers must submit plan notification through the e-referral system, while in the Mid, West, and Upper Peninsula regions, plan notification isn't required.

To help you navigate the authorization process, BCBS Michigan provides several resources, including the e-referral User Guide, the e-referral Quick Guide, and the Provider Manuals.

For another approach, see: Bcbs Referral

Health care providers must submit both prior authorization requests and plan notifications before providing services. See the e-referral User Guide to learn how.

Some services require prior authorization, including acute inpatient admissions, air ambulance, and pain management services.

Providers must submit plan notification to BCN through the e-referral system in the East and Southeast regions, but not in the Mid, West, and Upper Peninsula regions.

Explore further: Prior Authorization Services

Prior authorization is required for services like chiropractic care, laboratory services, and medical benefit drugs.

The review process for prior authorization can take up to seven days for non-urgent requests, three days for urgent requests, 24 hours for urgent concurrent review, and 30 days for post-service review.

Here are some services that require prior authorization: