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October 2017
We’re changing how behavioral health facilities handle certain requests for Medicare Plus BlueSM members
Starting Oct. 16, 2017, the way Blue Cross Blue Shield of Michigan Medicare Plus BlueSM PPO behavioral health facilities submit initial authorization requests, concurrent reviews and discharge summaries will change for inpatient, partial hospitalization and intensive outpatient services. The changes will affect both substance use and mental health disorders.
Here’s a summary of the changes:
Type of request |
Current practice |
Changes effective Oct. 16 |
Initial authorization |
Initial authorization requests are submitted by phone. |
All initial authorization requests must be submitted via e-referral. You’ll need to complete a questionnaire within the e-referral system. |
Concurrent review |
Concurrent reviews are submitted by phone. |
You must submit requests for concurrent reviews through the e-referral system. You’ll need to complete a questionnaire within the e-referral system. |
Discharge summary |
Discharge summaries are submitted by fax or phone. |
You must submit discharge summaries through the e-referral system. Complete the Behavioral Health Discharge Summary form and attach it to the case in the e-referral system. The form is available at ereferrals.bcbsm.com. From the home page, click on Blue Cross and then on Behavioral Health. |
The Behavioral Health e-referral User Guide will be updated before Oct. 16, 2017, to include instructions for submitting requests for inpatient, partial hospitalization and intensive outpatient services for Blue Cross Medicare Plus Blue PPO members.
You can refer to the updated user guide for instructions on how to attach the Behavioral Health Discharge Summary form to the case in the e-referral system. The User Guide will also show you how to complete the questionnaire for a concurrent review.
You can access the user guide at ereferrals.bcbsm.com. Click on Blue Cross and then on Behavioral Health.
Sign up to use e-referral system
Facilities contracted with Blue Cross Medicare Plus Blue PPO that have not signed up for access to the e-referral system should apply immediately. Each utilization review user at each facility will need his or her own individual access.
To get access to e-referral, you must register to use the Blue Cross Provider Secured Services portal. Go to ereferrals.bcbsm.com and click on Sign Up or Change a User. Follow the instructions under the heading “To sign up as a new e-referral user.”
These instructions apply whether your facility is new to Provider Secured Services or you’re already signed up for Provider Secured Services and just need access to the e-referral system.
It’s crucial that you sign up as soon as possible because granting access takes some time and you’ll need access before Oct. 16.
Note: The information in this article applies only to services for Blue Cross Medicare Plus Blue PPO members. For Blue Cross PPO (commercial) members, the instructions are different. Most, but not all, Blue Cross PPO members have their behavioral health coverage managed by New Directions. For those members, you can use the New Directions WebPass tool online at webpass.ndbh.com to request initial and continuing stay authorizations for inpatient admissions and check the status of these requests. You can also call 1-800-762-2382.
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