March 2021

How to submit appeals of Medicare Advantage inpatient acute care admissions

Providers who need to submit appeals for denied authorization requests for Medicare Plus Blue℠ and BCN Advantage℠ inpatient acute care admissions (non‑behavioral health) should follow the process described in the provider manuals. Instructions can also be found in the denial letters Blue Cross Blue Shield of Michigan or Blue Care Network send providers.

Medicare Plus Blue

For Medicare Plus Blue members, providers can find the process in the “Contracted MI Provider Acute Inpatient Admission Appeals” section of the Medicare Plus Blue℠ PPO Provider Manual.

Here’s a screenshot:

Inpatient Admission Appeals Screenshot 1

BCN Advantage

For BCN Advantage members, providers can find instructions in the “Utilization Management” chapter of the BCN Provider Manual. Look in the section titled “Appealing utilization management decisions.”

Here’s a screenshot:

Appealing utilzation management decisions screenshot 1

Appealing utilzation management decisions screenshot 2

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