Get easy access to information about our care management and utilization management programs

We publish the overview document to help you navigate our care management and utilization management programs. We recently updated this document and the documents linked within it to reflect changes that went into effect on Jan. 1, 2024. We’ll continue to make updates as information changes.

This easy-to-use, one-page document tells you what you need to know about these two categories of programs:

• Care management and support services — Care management programs provide patient support by identifying patients with health risks and working with them to improve or maintain their health, and support services provide support to members through their health journeys.
• Utilization management — These programs focus on ensuring that patients get the right care at the right time in the right location through the prior authorization process.

The programs vary based on member coverage and may be administered by Blue Cross Blue Shield of Michigan or Blue Care Network staff or by contracted vendors.

You can access the document using the links above or by clicking on the Care and utilization management programs: Overview for providers link at the bottom of each page of our ereferrals.bcbsm.com website.