Reminder: Preauthorization required for certain behavioral health services and concurrent reviews for Medicare Plus Blue PPO members

For Medicare Plus Blue℠ PPO members, behavioral health inpatient, partial hospitalization and intensive outpatient services continue to require preauthorization. To obtain preauthorization, providers must submit requests for initial admissions and extensions of treatment through e-referral.

This process excludes acute detoxification admissions, which should be processed as a medical service and follow the preauthorization requirements for regular inpatient admission. Outpatient behavioral health services for Medicare Plus Blue members don’t require prior authorization.

We use InterQual criteria to determine the medical necessity of the services. Cases that don’t meet criteria won’t be approved. Providers may obtain a copy of the criteria used to render all decisions. They can also speak with the behavioral health medical director regarding medical necessity decisions by calling Medicare Plus Blue Behavioral Health Services at 1-888-803-4960.

How do I appeal denied services?
Providers can appeal denied services by faxing an appeal request to 1-866-315-0442 or emailing the request to AABHMAPPO@bcbsm.com.

For peer-to-peer conversations with Blue Cross Blue Shield of Michigan behavioral health medical directors, call 1-877-293-2788 to discuss cases that don’t meet criteria for approval.

For more information, refer to the “Utilization management” chapter of the Medicare Plus Blue PPO Manual. Review the section titled “Preauthorization of behavioral health services.”