Voluntary prior authorization ends May 1

Effective May 1, 2023, Blue Cross Blue Shield of Michigan will no longer accept voluntary prior authorization requests. This change is a result of the new Michigan prior authorization legislation (referred to as Public Act 60), signed into law on April 7, 2022. Due to the new Michigan prior authorization requirements, Blue Cross will devote its resources to evaluating only those prior authorizations that are required by the patient’s benefit plan.

We encourage you to familiarize your team with the self-service tools available on our provider portal (availity.com**) to better determine whether a service will be covered. If you need assistance with navigating Availity^®, view a recorded webinar at Get Up to Speed with Training.**

Reminders

Before rendering services, make sure you check benefits, eligibility and medical policy coverage guidelines, using the self-service tools on our provider portal. Here are some reminders:

• Check benefits and eligibility at availity.com.**
• View benefit details through Benefit Explainer. This is available on the Applications tab within the Blue Cross and BCN Payer Space in availity.com.**
• Review medical policy through our Medical Policy Router Search.
• You can also check benefits and eligibility or request assistance by calling Provider Inquiry:
• Professional: 1-800-344-8525
• Facility: 1-800-249-5103

Additional information

The change related to voluntary prior authorizations only affects prior authorizations that are voluntary, sometimes referred to as “voluntary preapprovals.” The current process, which ends May 1, is described in the “Preapproval of Services Chapter” of the Blue Cross Commercial Provider Manual.

The ending of voluntary prior authorizations doesn’t affect any of the required Blue Cross prior authorization programs, which you can find by:

• Reviewing the Summary of utilization management programs for Michigan providers document
• Checking authorization requirements for a specific Blue Cross patient on our provider portal as follows:
1. Log in to our provider portal (availity.com**).
2. On the Patient Registration dropdown, click on Authorization & Referrals.
3. Click on Authorization Request and complete the requested information to determine if a certain procedure requires a prior authorization.

Watch for additional information in future issues of The Record.

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.