How to submit prior authorization requests for inpatient admissions involving elective surgeries

When submitting a prior authorization request for a Blue Cross Blue Shield of Michigan commercial member admitted for an inpatient elective surgical procedure, do the following:

• Enter only the primary procedure code for the surgery. If you enter additional procedure codes, the claim may not be paid.
• Include the supporting diagnosis code.

Blue Cross utilization management nurses who review the request only look at primary procedure and supporting diagnosis codes to determine whether the surgery meets the medical necessity criteria for an inpatient setting.

Be sure to check the member’s benefits and eligibility for the surgery and any other planned procedures.

Note: For inpatient medical admissions that don’t involve surgeries, enter procedure code *99222 for the admission.

Use Availity^® to check benefits and eligibility

To check the member’s eligibility and benefits:

1. Log in to our provider portal at availity.com.**
2. Click on Patient Registration on the menu bar and then click on Eligibility and Benefits Inquiry.
3. Follow the prompts to enter information, locate a patient and review their eligibility and benefits information.

Use the e-referral system to submit the prior authorization request

Once you’ve checked the member’s eligibility and benefits, submit the request through the e-referral system. Here’s how to access the e-referral system through availity.com.**

1. Click on Payer Spaces on the menu bar and then click on the BCBSM and BCN logo.
2. Click on the e-referral tile on the Applications tab.

Submit the prior authorization request as outlined in the “Submit an inpatient authorization” section of the e-referral User Guide.

Availity^® is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to offer provider portal services.

**Blue Cross Blue Shield of Michigan and Blue Care Network don’t own or control this website.