What to do when voluntary prior authorization ends May 1

The February 2023 issue of The Record announced the end of voluntary prior authorization requests in the article “Voluntary prior authorization ends May 1.”

If you have a procedure coming up for a Blue Cross Blue Shield of Michigan patient after May 1 and you’re not sure whether it will be covered or not, here are some steps you should take:

1. Check eligibility and benefits — First, make sure the patient’s coverage is in effect and the procedure is a covered benefit. You can do this within our provider portal at availity.com** by clicking on Eligibility and Benefits Inquiry. If additional details are available within Benefit Explainer, you’ll see a link to Benefit Explainer near the logo toward the top of the member’s benefits screen.
2. Check if prior authorization is required — Within our provider portal, click on Authorization Request in the Patient Registration drop-down menu. Complete the information for the specific patient and procedure. This application will tell you if a prior authorization is required and, if so, where to submit the request.
3. Check medical policy — Check for further coverage details within the medical policy. Go to Medical Policy Router Search and type in a keyword or procedure code to learn more about medical policy coverage.
4. Contact Provider Inquiry — If coverage of the procedure is still not clear, contact Provider Inquiry for assistance:
• Professional: 1-800-344-8525
• Facility: 1-800-249-5103

Some procedures require prior authorization

Blue Cross requires prior authorization for some procedures. You can determine whether a procedure requires prior authorization for a specific patient by using the Authorization Request application described in Step 2 above. You can also reference the following resources for a summary of prior authorization requirements:

• Summary of utilization management programs for Michigan providers
• PPO Provider Preauthorization and Precertification Requirements

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

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