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April 2013

Precertify detox treatment for State of Michigan employees

Acute care hospitals must submit a precertification request when admitting State of Michigan employees for substance abuse detoxification treatment (including alcohol withdrawal).

Please follow this process:

  1. Determine if the patient is a State of Michigan employee (BCBSM group number 007000562).
  2. If the patient is a State of Michigan employee, fill out the Acute Inpatient Fax Assessment Form (PDF).
  3. Fax the form to 1-866-411-2585 or email it to acuteprecertification1@bcbsm.com.

Please remember that if the incoming patient is not a State of Michigan employee, please call Magellan Behavioral
at 1-800-762-2382 for precertification.

If you have questions, please contact your provider consultant.

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 2012 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.