What to do now that voluntary prior authorization has ended

As we reported in the February and April 2023 issues of The Record, Blue Cross Blue Shield of Michigan stopped accepting voluntary prior authorization requests on May 1, 2023.

Before providing services to members, be sure to follow all these steps:

1. Check eligibility and benefits — Make sure the patient’s coverage is in effect and the procedure is a covered benefit. You can do this within our provider portal (availity.com)** by clicking on Patient Registration in the menu and then clicking on Eligibility and Benefits Inquiry. If additional details are available within Benefit Explainer, you’ll see a link to Benefit Explainer near the logo toward the top of the member’s benefits screen.


2. Check whether prior authorization is required — Within our provider portal, click on Patient Registration in the menu and then click on Authorization Request. Complete the information for the specific patient and procedure. This application will tell you if a prior authorization is required and, if so, where to submit the request. For detailed information, see the document titled Determining prior authorization requirements for members.


3. Check the medical policy — Check for further coverage details within the medical policy. Go to our Medical Policy Router Search tool and type in a keyword or procedure code to learn more about medical policy coverage.


4. Call Provider Inquiry if coverage of the procedure still isn’t clear — If you have questions, call Provider Inquiry as follows.

• Professional: 1-800-344-8525
• Facility: 1-800-249-5103

Some procedures require prior authorization, as stated in Step 2 above. For summary information about prior authorization requirements, see the following documents:

• Summary of utilization management programs for Michigan providers
• Provider preauthorization and precertification requirements for Blue Cross commercial and Medicare Plus Blue℠

Availity^® is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to offer provider portal and electronic data interchange services.

**Blue Cross Blue Shield of Michigan doesn’t own or control this website.