We’re aligning peer-to-peer review request processes for acute non-behavioral health non-elective inpatient admissions

For acute non-behavioral health non-elective inpatient admissions, the process for requesting a peer-to-peer review with a Blue Cross Blue Shield of Michigan or Blue Care Network medical director is now the same for all lines of business. This applies to inpatient admission authorization requests denied for Blue Cross’ PPO, Medicare Plus Blue^SM PPO, BCN HMO^SM and BCN Advantage^SM members.

Here’s what you need to know about peer-to-peer review requests for acute non-behavioral health non-elective inpatient admissions:

• Submit all requests using the Physician Peer-to-Peer Request Form (for non-behavioral health cases). Complete the form and fax it to 1-866-373-9468 during normal business hours of 8 a.m. to 5 p.m. (except weekends and holidays).
  
  Note: We’ll reach out to you the next business day. The peer-to-peer review will be scheduled on business days, Monday through Friday between 9 a.m. and 4 p.m. (except holidays).

• Using the form is mandatory starting Jan. 1, 2020.
  
  Note: Currently, for Blue Cross’ PPO and Medicare Plus Blue requests, you call 1-866-346-7299 to request a peer-to-peer review. However, on Jan. 1, 2020, that number will be taken out of service.

• The request process isn’t changing for BCN HMO and BCN Advantage. It’s the process for Blue Cross’ PPO and Medicare Plus Blue requests that’s changing. Currently, you submit BCN requests using the form.

• The form is available on our ereferrals.bcbsm.com website, on the Blue Cross Authorization Requirements & Criteria page and the BCN Authorization Requirements & Criteria page. The form has been updated for use with all lines of business.

Additional information
For information about requesting peer-to-peer reviews on denied authorization requests for various types of services, refer to the description of the process in the document How to request a peer-to-peer review with a Blue Cross or BCN medical director. This document is also available on the Blue Cross and BCN Authorization Requirements & Criteria pages on the ereferrals.bcbsm.com website.

The only process that’s changing is the one for requesting acute non-behavioral health non-elective inpatient admissions. The processes for requesting peer-to-peer reviews for other types of services are staying the same.