The Record

Facilities must submit appeals within required time frames

What you need to know

We reinstated the time frames for submitting appeals for nonapproved prior authorization requests on July 1, after waiving those time frames during the COVID-19 public health emergency.
The time frames for Level One and Level Two appeals are highlighted in the chart below.
You can find more information in our provider manuals.

Facilities must submit appeals of nonapproved inpatient medical and surgical (non-behavioral health) prior authorization requests within the time frames stated in the denial letters.

We reinstated the usual appeals time frames on July 1

During the COVID-19 public health emergency, Blue Cross Blue Shield of Michigan and Blue Care Network waived the time frames for submitting appeals. We reinstated the time frames for submitting appeals, starting July 1, 2023. This was communicated in a May 1, 2023, provider alert.

Time frames for submitting appeals

Here are the time frames for submitting appeals of inpatient medical and surgical (non‑behavioral health) prior authorization requests that we’ve denied:

For initial denial decisions made before July 1, 2023, we’ll stop accepting appeals on Jan. 1, 2024.

For initial denial decisions made on or after July 1, 2023, the usual time frames for appeals apply; see the table below.

Plan

How it works

Blue Cross commercial

A Level One appeal must be submitted within 45 days of the date on the original denial letter. Appeals submitted after the 45th day won’t be accepted.
A Level Two appeal must be submitted within 20 days of the date on the Level One appeal denial letter. Appeals submitted after the 20th day won’t be accepted.

Medicare Plus Blue℠
BCN commercial
BCN Advantage℠

A Level One appeal must be submitted within 45 days of the date on the original denial letter.
A Level Two appeal must be submitted within 21 days of the date on the Level One appeal denial letter.
If a Level One appeal is submitted after the 45th day but by the 66th day, it will be processed as a Level Two appeal.
Appeals received more than 66 days after the date on the original denial letter won’t be accepted.

Where to find additional information

For additional information about submitting appeals of prior authorization requests that aren’t approved, refer to the pertinent provider manual:

Blue Cross commercial: Refer to the “Preapproval of Services” chapter. Look in the section titled “Appealing a prior authorization decision.”

Medicare Plus Blue: In the Medicare Plus Blue PPO Provider Manual, look in the section titled “Appealing Medicare Plus Blue’s Decision.”

BCN commercial and BCN Advantage: Refer to these two chapters in the BCN Provider Manual:

In the “BCN Advantage” chapter, look in the section titled “BCN Advantage provider appeals.”
In the "Utilization Management” chapter, look in the section titled “Appealing utilization management decisions.”

To access the provider manuals:

Click on Payer Spaces on the menu bar and then click the BCBSM and BCN logo.

Click on the Resources tab.

Click on Provider Manuals.

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