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January 2020

Provider appeal time frame extended for Blue Cross’ PPO admissions

You now have up to 45 days to submit appeals for denied authorization requests related to admissions of Blue Cross Blue Shield of Michigan’s PPO (commercial) members.

This applies to admissions for:

  • All members with a Blue Cross PPO contract
  • Care in acute inpatient settings, skilled nursing facilities, long-term acute care hospitals and inpatient rehabilitation settings

You must submit the appeal within 45 days of the date that the initial request was denied.

Changing the appeal submission deadline from 30 to 45 days brings the Blue Cross PPO appeal deadline requirements into alignment with requirements for other Blue Cross and Blue Care Network products. The Blue Cross provider manuals will be updated to reflect this change.

We’ve extended the time frame to 45 days to accommodate the increased number of requests for peer-to-peer reviews and the time it’s taking to schedule those reviews. As a reminder, peer-to-peer review requests must be submitted within 14 days of the denial and before an appeal.

For more information on submitting a request for a peer-to-peer review, refer to the document “How to request a peer-to-peer review with a Blue Cross or BCN medical director,” which we recently updated.

To access this document:

  • Go to  ereferrals.bcbsm.com.
  • Click on Blue Cross.
  • Click on Authorization Requirements & Criteria.
  • Look under the Forms – Blue Cross PPO (commercial) heading.

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 2019 American Medical Association. All rights reserved.