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December 2021

Overview of care management and utilization management programs now available

Blue Cross Blue Shield of Michigan and Blue Care Network have implemented many care management programs for members and utilization management programs for providers.

  • Care management programs provide patient support by identifying patients with health risks and working with them to improve or maintain their health.
  • Utilization management programs focus on ensuring that patients get the right care at the right time in the right location through the authorization process.

These programs vary based on member coverage and may be administered by Blue Cross or BCN staff or by contracted vendors.

We recently published the Care management and utilization management programs: Overview for providers document to help you navigate these programs. This information may help you to identify services that could be useful to your patients or to learn more about programs in which your patients are participating.

In the overview document, we’ve:

  • Categorized the programs and the services for which we have care management and utilization management programs.
  • Listed who provides services within each category (Blue Cross or BCN staff, contracted vendors or both).
  • Indicated whether services are available to Blue Cross commercial, Medicare Plus Blue℠, BCN commercial or BCN Advantage℠ members

To see more details about the programs, click a category heading. A document will open that provides:

  • A summary of available services
  • The groups and individual members to which services are available
  • Resources for finding more information

You can access the overview document by going to ereferrals.bcbsm.com, clicking on the Quick Guides link (under Additional Resources) and then clicking on the Care management and utilization management programs: Overview for providers link.

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 2020 American Medical Association. All rights reserved.