For Providers: What are the Prior Authorization Requirements for Services for Medicare Advantage Members?

Some services for Medicare Plus BlueSM PPO and BCN AdvantageSM  members require health care providers and facilities to work with us or with one of our contracted vendors to request prior authorization before beginning treatment.

Prior authorization requirements

See the links within the accordions for information on prior authorization requirements for specific services. These lists aren't all-inclusive. You can learn more by clicking the link to go to the pertinent page on our website.




Non-Michigan providers

Non-Michigan providers who treat Medicare Advantage members who travel or live outside of Michigan should review the following documents: 

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Related forms and documents

Summary of Utilization Management Programs for Michigan Providers (PDF)
BCBSM and Blue Care Network Prior Authorization/Step Therapy Guidelines (PDF)
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