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Member Benefits

Blue Cross Blue Shield of Michigan Medicare Advantage members:

  • Are not restricted to provider networks.

  • Do not need referrals to specialists or for other services.

  • Can obtain services from any willing provider in the United States who is eligible to be paid under Medicare rules.

For more detailed information about BCBSM Medicare Advantage member benefits, review the member's Benefit Summaries and the Additional Benefits.

 

Medical Care Management

BCBSM Medicare Advantage members have access to two excellent medical care management programs that promote quality health care services based on the member’s health status.

 

The following programs are designed to assist BCBSM Medicare Advantage members:

  • Preadmission Notification

  • Care Management Programs
    • Health Care Management
    • Disease Management
    • Case Management

Preadmission Notification

Preadmission notification applies to hospitals, hospitals with swing beds, skilled nursing facilities, rehabilitation facilities (free-standing facilities and units within hospitals), long-term care hospitals, mental health (free-standing facilities and units within hospitals) and substance abuse facilities.

 

To preserve continuity of care, we encourage the facility to notify BCBSM Medicare Advantage when admitting a BCBSM Medicare Advantage member.

 

However, you do not need to request or receive prior authorization from BCBSM Medicare Advantage in order to admit members.

 

Facilities: Acute care hospitals with web-DENIS should use it for preadmission notification. All other Michigan providers and those outside of Michigan should call BCBSM Medicare Advantage at 800-572-3413 and provide the following information:

  • Health care facility and type of facility

  • Member’s name, sex and BCBSM Medicare Advantage contract number

  • Attending physician’s name and phone number

  • Estimated length of stay, admitting diagnosis and planned procedures (if applicable)

Learn more about Care Management.

Care Management Programs

Care management programs are available to BCBSM Medicare Advantage members. Providers both in and outside of Michigan are encouraged to refer patients to these programs when appropriate.

  • Health care management assists your patients with their health care concerns. BlueHealthConnection® provides members with health information and support to help them understand their health care issues, address their concerns, and work more closely with their providers. Eligible members have access to a wealth of health information and support including:

    • Online health information at www.bcbsm.com. Members can access BlueHealthConnection to view articles, tools and quizzes that provide a wide variety of health information on thousands of topics.

    • Access to health coaches (usually registered nurses) 24 hours a day, seven days a week, to help members access health information and answer their health questions

  • Disease management supports members with chronic conditions like diabetes, heart disease or asthma. Members can work one-on-one with BlueHealthConnection coaches to understand their condition and ways to manage it.

You may refer BCBSM Medicare Advantage members for either health care management or disease management programs by having them call 877-922-9355 any day, 24 hours a day. The TTY number is 800-817-9430. Or they can visit us on the Web at bcbsm.com.

  • Case management assists in the day-to-day clinical management of patients with complex health issues. Once a patient is accepted into the program, patient care needs are coordinated through Care Guide (formerly known as Coordinated Care Solutions) with a treating physician.

    Care Guide will also visit face-to-face with members and their families who qualify for case management services.

Facilities may refer members for review by contacting Care Guide at 888-882-4369 (voice) or 800-418-1360 (TTY).