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March 2013
Facility precertification request for BCBSM members moving to electronic, fax process
Starting March 1, 2013, Blue Cross Blue Shield of Michigan’s Precertification Services department will no longer accept precertification requests by phone.
Requests for precertification and recertification of BCBSM member inpatient admissions (acute hospital, skilled nursing facility and acute rehab) must be submitted in the following ways:
- Michigan acute inpatient hospitals should follow the established prenotification process in web-DENIS.
- All facility types can submit requests via the electronic 278 Standard Transaction. If you are interested in utilizing the 278 Standard Transaction, email EDICustMgmt@bcbsm.com for assistance.
- All facility types can submit requests via email or fax to the BCBSM Precertification department. Facilities should complete the appropriate facility request form located on BCBSM’s provider website and fax or email the form as explained below.
- Acute inpatient hospital requests and Chrysler out-of-state radiology only:
- Skilled nursing facility and acute inpatient rehabilitation requests:
- For MESSA members, call MESSA at the number on the back of the member’s ID card to precertify services.
You may submit precertification requests 24 hours a day, seven days a week. Requests will be processed during regular business hours Monday through Friday. Standard turnaround time is four hours. All requests received prior to 4 p.m. Eastern Time will be completed on the same business day. Determinations will be communicated by BCBSM via phone and email.
Please note that precertification is not required for:
- Outpatient services and outpatient procedures
- Maternity-related admissions, including cesarean-section
- Observation or short stay
- Durable medical equipment
- Home health care
- Cases in which BCBSM is the secondary insurer (for example, Medicare is primary)
Radiology services must be precertified by calling AIM at 1-800-728-8008. For UAW Retiree Medical Benefits Trust members, call Care Core at 1-888-835-2042.
Please begin using these options as soon as possible. The departmental phone lines will remain open until Thursday, Feb. 28, 2013. Facilities attempting to reach Precertification Services by phone after that day will hear an automated message outlining the appropriate fax submission process and related resources.
Over the next 30 days, we plan to restructure our staffing resources to ensure one-day turnaround during regular business hours to all precertification requests. Members and health care providers who have questions about a specific case or inpatient precertification decision can call 1-866-346-7299 for help.
Soon you will be able to access submission forms and instructions on web-DENIS by clicking BCBSM Provider Publications and Resources, then Newsletters & Resources. The submission forms and instructions are also available on our BCBSM provider website.
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