Reminder: Changes coming to prior authorization, case management functions for behavioral health services in January

Starting Jan. 1, 2024, Blue Cross Blue Shield of Michigan and Blue Care Network will consolidate the prior authorization and case management functions for behavioral health services, including treatment for autism.

We recently communicated these changes in The Record and BCN Provider News.  

Prior authorization and concurrent review requests will be managed through Blue Cross Behavioral Health℠ . Case management services will be handled through Blue Cross Coordinated Care℠ . These programs will align and standardize prior authorization and case management functions for members. The changes will affect most members covered by Blue Cross commercial, Medicare Plus Blue℠, BCN commercial and BCN Advantage℠ plans.

Find details in the FAQ

We updated the Blue Cross Behavioral Health: Frequently asked questions for providers document with the latest information. Here are the most recent changes:

• In the “Submitting prior authorization requests and concurrent review requests” section:
• We outlined how to submit requests electronically and by phone, before and after Jan. 1.
• We listed the medical necessity criteria we’ll use to make determinations on these requests.
• In the “Autism evaluation and treatment changes” section, we added information about:
• Additional opportunities for members to obtain a comprehensive diagnostic autism evaluation prior to starting treatment
• How to request a “bridge authorization,” which allows members to start applied behavior analysis, or ABA, treatment while they’re in the process of completing the components of the comprehensive evaluation
• In the “Appeals” section, we updated the information to show that you should follow the instructions in the determination letter to submit an appeal of a request that wasn’t approved.

You can access the FAQ at ereferrals.bcbsm.com on the:

• Blue Cross Behavioral Health and Autism pages
• BCN Behavioral Health and Autism pages

Watch for a recorded webinar

In December, we’ll publish a recorded webinar, which will provide:

• An overview of the changes
• Instructions on how to access and use the Blue Cross Behavioral Health provider portal
• Information about where to locate important resources
• Watch for upcoming communications on how to access the webinar.