Here’s what you need to know about authorization requirements for different types of members

Over the past two months, we’ve received several authorization requests through the e-referral system for procedures for Blue Cross Blue Shield of Michigan PPO (commercial) members that didn’t require authorization.

Keep in mind that the list of Services That Require Authorization for procedures that require authorization, as of July 31, 2017, applies only to Blue Cross Medicare Plus Blue^SM members.

Here’s a summary of what’s required for both sets of members:

For procedures

• For Blue Cross Medicare Plus Blue members: Professional providers must submit authorization requests through the e-referral system for the procedures listed on the Services That Require Authorization document. Authorization criteria related to these procedures are now available on the Blue Cross Authorization Requirements & Criteria page on ereferrals.bcbsm.com.
• For Blue Cross PPO (commercial) members: Professional providers should continue to request authorization only for procedures that currently require it, such as the radiology procedures submitted through AIM and a few others. Joint replacements and similar procedures that require authorization for Blue Cross Medicare Plus Blue members, starting July 31, 2017, don’t require authorization for Blue Cross commercial members.

For inpatient admissions

• Facility providers should submit authorization requests for inpatient admissions through the e-referral system for dates of service on or after July 31, 2017, instead of using the prenotification system that's been used for these requests in the past.
• For issues related to Blue Cross commercial member authorizations, call 1-800-572-3413.
• For issues related to Blue Cross Medicare Plus Blue member authorizations, call 1-866-309-1719.
• To add a temporary member to Blue Cross commercial, such as a newborn admitted to a neonatal intensive care unit, fax requests to 1-866-411-2585.