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October 2017

Preauthorization program for commercial Blue Cross PPO plans coming in January

Beginning Jan. 1, 2018, our fully insured and IBU commercial Blue Cross Blue Shield of Michigan PPO plans will require preauthorizations for the following services:

  • Interventional pain management
  • Radiation therapy (oncology) services
  • Inpatient and outpatient lumbar spinal fusion surgery

These programs will be administered by eviCore healthcare, a national specialty benefits management company that focuses on quality, cost and use of health care services.

MESSA is currently excluded. Auto groups and the UAW Retiree Medical Benefits Trust are also excluded. Blue Care Network HMO isn’t affected by this change.

Similar eviCore preauthorization programs were rolled out for Michigan Medicare Plus BlueSM PPO members in 2016.

For more information

Look for more detailed information in the November issue of The Record about the commercial PPO preauthorization program, including:

  • Opportunities for training (encouraged for resources involved in the preauthorization and billing processes)
  • Details about the preauthorization process
  • How to identify members who require preauthorization

Once the eviCore implementation site is live, it will include information on forms, guidelines, FAQs and other pertinent details.

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 2016 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.