Referrals

Depending on which Blues plan coverage your patient has, you may need to give a referral outside our network. Use these forms for that process. 

Blue Cross Blue Shield of Michigan Referrals

• Dentist to Physician referral form (PDF)
• Physician to Dentist referral form (PDF)
• TRUST/PPO Program Referral Form (PDF)
• BCBSM U.P. Blue Out-of-State Referral Preauthorization (PDF) - This form can only be used by Michigan PPO providers and can't be used by out-of-state providers.
  

Blue Care Network Referrals

Use our e-referral system to submit your referrals electronically. With e-referral, you can:

• View existing referrals and plan approvals 
• Request plan approvals and most inpatient admissions 
• Submit OB admission requests 
• Report services associated with global referrals