Eligibility, precertification and preauthorization contacts

Blue Cross Blue Shield of Michigan gives providers two ways to find patient eligibility information — by logging into our Provider Secured Services site or by calling our automated response system.

 

Access Provider Secured Services

Our secured site lets you find patient information quickly.

Not yet registered? Learn how to get an account.

Call our automated response system

Our automated response system is for registered, nonregistered and out-of-state providers. It can tell you about your patient's eligibility and benefits and cost-share information. It also can connect you with a representative to learn more about precertifications and preauthorizations.

Eligibility and benefits

Patient eligibility and benefits includes cost-share information, such as copays and deductibles, and benefit-specific information, such as how long a hospital stay might be covered.

Precertification for hospitals and facilities

Precertification is our assessment of your patient's symptoms and your proposed treatment plan, in advance of care. We require precertification for the following inpatient facilities:

  • Acute inpatient settings
  • Skilled nursing settings
  • Rehab settings

Preauthorization for physicians and professionals

Preauthorization lets providers know if Blue Cross Blue Shield of Michigan will cover the cost of a proposed service before treating a patient. We require preauthorization for services that may be experimental, overused or not always medically necessary.

If you’re not sure if you need a preauthorization, read more about our clinical guidelines on our Medical Policy page.