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August 2018

Find out how to request peer-to-peer reviews for inpatient admissions

Blue Cross Blue Shield of Michigan and Blue Care Network allow facility onsite physician advisers to discuss reviews of inpatient admissions with a Blue Cross or BCN medical director. This applies to members with coverage through BCN commercial, BCN AdvantageSM, Medicare Plus BlueSM and Blue Cross commercial products.

The purpose of these peer-to-peer conversations is to discuss the clinical and medical necessity nuances of a member’s medical condition that requires an inpatient admission or authorization for a service that’s not part of the InterQual® criteria or our local rules. The facilities involved in the program agree to initiate peer-to-peer conversations only through their employed physician advisers and not through third-party advisers or organizations.

For patients with BCN coverage:
Here’s how to request a peer-to-peer review with a BCN medical director:

  1. Call 248-799-6312.
  2. Select prompt 3 for a peer-to-peer review.
  3. Leave a message with the following information:
    • Physician adviser’s or physician’s name and phone number
    • Member’s name, date of birth and contract number
    • Reason for requesting a peer-to-peer review
    • Best date and time to reach the physician adviser or physician

For patients with Blue Cross coverage:
Here’s how to request a peer-to-peer review with a Blue Cross medical director:

  1. Call 1-866-346-7299.
  2. Select the prompt for “Facility Precertification Department” (press No. 2).
  3. Select the prompt for “Provider Peer-to-Peer Review.”
  4. Leave a message with the following information:
    • Physician adviser’s name and phone number
    • Member’s name, date of birth and contract number
    • Reason for requesting a peer-to-peer review
    • Best date and time to reach the physician adviser

For behavioral health cases
Here’s how to request a peer-to-peer review for inpatient admissions related to BCN, BCN Advantage and Medicare Plus Blue products:

  1. Call 1-877-293-2788.
  2. If the call isn’t answered live, leave a message with the following information:
    • Name of person calling and call-back number
    • Physician adviser’s or physician’s name and phone number
    • Member’s name, date of birth, contract number or case number
    • Reason for requesting a peer-to-peer review
    • Best date and times to reach the physician adviser or physician

Blue Cross PPO members should call the behavioral health number on the back of the member's Blue Cross ID card.

The peer-to-peer phone line is open 8 a.m. to 5 p.m. Monday through Friday, except for holidays. Calls will be returned within 48 business hours.

No portion of this publication may be copied without the express written permission of Blue Cross Blue Shield of Michigan, except that BCBSM participating health care providers may make copies for their personal use. In no event may any portion of this publication be copied or reprinted and used for commercial purposes by any party other than BCBSM.

*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2017 American Medical Association. All rights reserved.
Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and
independent licensees of the Blue Cross and Blue Shield Association.