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

Some services for Medicare Plus BlueSM PPO and BCN AdvantageSM  members require practitioners and facilities 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.  This list is not all-inclusive, so you can learn more by clicking on the Blue Cross links on our ereferrals site. Many of these webpages have a section for Medicare Plus Blue or BCNA.




Non-Michigan providers

Non-Michigan providers who treat Medicare Plus Blue members who travel or live outside of Michigan should review the Medicare Plus Blue PPO Fact Sheet (PDF). Non-Michigan providers who treat BCN Advantage members should review the Non-Michigan providers: Referral and Authorization Requirements (PDF).

Still need help?
Contact us




Related forms and documents

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