What you need to know about submitting medical benefit drug prior authorization requests for Medicare Advantage members

Blue Cross Blue Shield of Michigan and Blue Care Network recently transitioned to a new provider portal, Availity Essentials. You should continue to submit prior authorization requests for most medical benefit drugs, including CAR-T cell therapy drugs, for Medicare Plus Blue℠ and BCN Advantage℠ members in one of the following ways:

• Preferred method: Through the NovoLogix^® online tool. See the next section for the steps you need to take to access NovoLogix through Availity^®.
• For providers who aren’t able to submit requests through NovoLogix: You have two options:
• Use the new global Medication Authorization Request Form (for any medication), which we created to reduce the number of forms you have to manage. Fax the completed form to 1-866-392-6465.
• Call our Pharmacy Clinical Help Desk at 1‑800-437-3803.

Preferred method for submitting prior authorization requests

The preferred method continues to be submitting requests through NovoLogix.

Note: If you haven’t already done so, be sure to register for Availity so you can continue to submit requests through NovoLogix.

If you have an Availity account, you have access to NovoLogix.

To submit requests through Availity:

1. Log in to our provider portal (availity.com**).
2. Click on Payer Spaces on the Availity menu bar.
3. Click on the BCBSM and BCN logo.
4. In the Applications tab, click on the appropriate tile:
• NovoLogix MAPPO
• NovoLogix BCN/BCN Advantage

Additional information

You can access the Medication Authorization Request Form (for any medication) on the For Providers: How do I Submit a Drug Prior Authorization Request for Medicare Plus Blue PPO and BCN Advantage? page of the bcbsm.com website. Later this year, we’ll remove the medical drug prior authorization request forms for specific medications.

For more information about submitting requests and to view the Medical Drug and Step Therapy Prior Authorization List for Medicare Plus Blue and BCN Advantage members, see the following pages of ereferrals.bcbsm.com website:

• Blue Cross Medical Benefit Drugs
• BCN Medical Benefit Drugs

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