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December 2017
We’ve changed how behavioral health facilities handle certain requests for Medicare Plus BlueSM members
On Oct. 16, 2017, Blue Cross Blue Shield of Michigan changed the way behavioral health facilities should submit initial authorization requests, concurrent reviews and discharge summaries for inpatient, partial hospitalization and intensive outpatient services for Medicare Plus BlueSM members. The changes affected 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 Blue Cross and then Behavioral Health. |
The Behavioral Health e-referral User Guide was updated 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 show you how to completethe 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 Medicare Plus Blue PPO that haven’t signed up for access to the e-referral system should apply immediately. Each utilization review user at each facility will need 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 time.
Note: The information in this article applies only to services for 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. Those members can use the online WebPass tool at webpass.ndbh.com ** to request initial and continuing stay authorizations for inpatient admissions, and check the status of these requests. They can also call 1-800-762-2382.
** Blue Cross Blue Shield of Michigan doesn’t own or control this website.
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