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April 2023
Here’s how to determine prior authorization requirements for patients with non-Michigan Blue plans
Michigan providers can find information about prior authorization requirements for patients with non-Michigan Blue plans as follows:
- Specific information may be available through Availity®. See the “Specific information” section below for details.
- General information is available through our Medical Policy & Pre-Cert/Pre-Auth Router. See the “General information” section later in this article for details.
Specific information
Specific information about prior authorization requirements may be available through Availity.
- Log in to our provider portal at availity.com.**
- Click on Patient Registration and then click on Authorizations & Referrals.
- Click on Authorization Request.
- In the Select a Payer screen, make these selections:
Field |
Selection |
Organization |
Select the appropriate organization. |
Payer |
Select BCBS Michigan and Blue Care Network. |
Request Type |
Select the appropriate type of request. |
- Click on Next.
- In the Select a Patient field, choose any patient.
- In the Member ID field, enter the subscriber ID from the non-Michigan member’s ID card. Be sure to include the three-character alpha prefix.
- Complete the fields in the Requesting Provider section and click Next.
- Based on what you see on the screen, complete the rest of the steps.
What you see on screen |
What to do |
“Important: You have been routed from BCBSM Michigan and Blue Care Network to BCBSXX to conduct pre-service review for a BCBSXX member.” |
- Click on the Inpatient Authorization or Outpatient Authorization link.
The Authorizations page opens to the Requesting Provider section.
- Scroll up to the Patient Information section at the top of the screen.
- Enter the non-Michigan member’s member ID, relationship to the subscriber, first and last name and date of birth.
- Enter the appropriate information in all required fields.
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A Blue Cross Blue Shield Association disclaimer that states: “You are about to be redirected to a third-party site, which may require a separate log-in…” |
- Click Submit.
- Follow the instructions in the screen that opens.
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General information
For general information about services that require authorization, go to our Medical Policy & Pre-Cert/Pre-Auth Router. To access the router:
- Go to bcbsm.com/providers.
- Click on Resources.
- Click on the out-of-area router link.
- Click on the General pre-certification/pre-authorization information option.
- Enter the three-character alpha prefix from the non-Michigan member’s subscriber ID in the Prefix field.
- Click on Go.
Additional information
You can also find this information in the Determining prior authorization requirements for a member document. That document also explains how:
- Michigan providers can look up requirements for patients who have coverage through Blue Cross Blue Shield of Michigan or Blue Care Network plans.
- Non-Michigan providers can look up requirements for patients who have coverage through Blue Cross Blue Shield of Michigan or Blue Care Network plans.
You can access this document by clicking on the Determine prior authorization requirements for members tile on the left side of any page of our ereferrals.bcbsm.com website.
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. | 