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May 2016

Look for new standardized paper prior authorization form, coming July 1

On July 1, 2016, Blue Cross Blue Shield of Michigan will begin using the new State of Michigan paper prior authorization form. It will help standardize the way doctors and insurers request and receive prior authorizations for prescription drug benefits.

Michigan Public Act 30 of 2013 amended the insurance code to require the creation of a single prior authorization form for use by health providers when a patient’s health plan requires prior authorization for prescription drug benefits.

This law applies to Blue Cross commercial members only, not Medicare members or drugs provided under the medical benefit. Also, a different process will be used for Blue Care Network and Medicare Part D members.

Prescribers can either submit an electronic preauthorization form online or request the paper form by calling the Clinical Help Desk at 1-800-437-3803.

Electronic submission
Blue Cross includes electronic prior authorization forms on bcbsm.com/providers for commercial members. Submitting electronically offers many advantages, including the following:

  • Ability to request prior authorizations 24 hours a day, seven days a week at your convenience
  • Convenience of starting a prior authorization, saving it if interrupted and then returning to it later without losing any entered data
  • Elimination of the need to wait on hold, make multiple calls or deal with multiple faxes relating to drug prior authorization requests
  • The ability of prescribers to look up the status of a drug prior authorization request.

New standardized paper submission
The new paper form doesn’t include all information that may be needed for a review or determination. However, the new law allows insurers to request additional information, including the following:

  • Diagnosis
  • Chart notes
  • Lab information
  • Genetic tests
  • Information necessary for the approval of the prior authorization request under plan criteria
  • Drug-specific information, including medication history, duration and treatment use
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 2015 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.