Changes for in-lab sleep studies start Oct. 9

Prior authorization requirements for in-lab sleep studies will change for dates of service on or after Oct. 9, 2023.

For dates of service on or after Oct. 9

• For Medicare Plus Blue℠ members, prior authorization won’t be required for in‑lab sleep studies. However, if the provider is out of network for the member’s plan, then prior authorization will be required.
• For BCN Advantage℠ members, plan notification will be required to facilitate claims payment. Prior authorization won’t be required.

For dates of service before Oct. 9

Continue to submit prior authorization requests as you do now. Specifically:

• For Medicare Plus Blue members, submit prior authorization requests to Carelon Medical Benefits Management through the Carelon ProviderPortal.
  Additional options for submitting requests are outlined on the Blue Cross Carelon-Managed Procedures webpage at ereferrals.bcbsm.com.
• For BCN Advantage members, submit prior authorization requests to BCN Utilization Management through the e-referral system.
• You must complete the sleep study questionnaire in the e-referral system.

Additional information

Before Oct. 9, we’ll update several documents to reflect these changes, including:

• Procedures that require prior authorization by Carelon: Cardiology, radiation oncology, radiology (high technology) and sleep studies (in lab)
• BCN referral and authorization requirements for Michigan providers 

Carelon Medical Benefits Management is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to manage prior authorizations for select services.