June 2022
July 4 holiday closure: How to submit inpatient authorization requests (PDF)
Oxlumo® to have site-of-care requirement for commercial members starting Oct. 1 (PDF)
Improved process for prior authorization requests for initial SNF stays for Medicare Advantage members (PDF)
Post-acute care providers need direct access to naviHealth’s provider portal (PDF)
Availity® administrators: Set up Health e-BlueSM tools within Availity (PDF)
e-referral system out of service on two weekends in June (PDF)
June 20 holiday closure: How to submit inpatient authorization requests (PDF)
Updated: Health e-BlueSM tools: Processing delays for access requests (PDF)
Reminder: Availity® administrators must take action now to ensure access to e-referral and Health e-BlueSM tools within Availity (PDF)
May 2022
Updated: Oral surgery questionnaire to open in e-referral system, starting May 29 (PDF)
Cortrophin® and Ryplazim® will have requirements for URMBT members with Blue Cross non-Medicare plans (PDF)
e-referral Type of Care definitions updated (PDF)
May 30 holiday closure: How to submit inpatient authorization requests (PDF)
Update: We're removing age limits for autism spectrum disorder services (PDF)
e-referral system out of service for maintenance overnight May 21-22 (PDF)
Additional medical benefit drugs to have site-of-care requirements for BCN commercial members starting Sept. 1 (PDF)
Fusilev® will no longer require prior authorization, starting May 31 (PDF)
Fyarro™ to require prior authorization for most members starting Aug. 16 (PDF)
Fyarro™ and Tivdak® will have requirements for URMBT members with Blue Cross non-Medicare plans (PDF)
Update: Inflectra® and Avsola® are the preferred infliximab products for pediatric commercial members starting July 1 (PDF)
Leqvio® to have site-of-care requirement for commercial members starting Aug. 1 (PDF)
Availity® administrators: Set up the e-referral tool within Availity (PDF)
Important news about submitting medical benefit drug prior authorization requests for Medicare Advantage members (PDF)
April 2022
AIM to ask for clinical information for Blue Cross commercial radiology and cardiology prior authorization requests (PDF)
We’re designating preferred and nonpreferred IV iron therapy replacement drugs for Medicare Advantage members (PDF)
Update: Time frames for determinations on authorization requests for acute inpatient medical admissions (PDF)
Availity® administrators: Ensure access to e-referral and Health e-BlueSM tools within Availity (PDF)
CareCentrix® home health care: HIPPS Questionnaire has been removed for Medicare Plus BlueSM members who receive services in Michigan (PDF)
Prior authorization requirements change for radiology code *71271 (PDF)
Updated: questionnaires to open in the e-referral system starting April 24 (PDF)
Availity® administrators: Set up Health e-BlueSM tools within Availity (PDF)
e-referral system out of service for maintenance overnight April 16-17 portal (PDF)
SecureCare® to manage outpatient PT, OT, ST, physical medicine and chiropractic services for Blue Cross commercial and Medicare Plus Blue, starting July 5 (PDF)
Medicare Advantage post-acute care: New 7-day limit on documents in naviHealth's nH Access™ portal (PDF)
April 15 holiday closure: How to submit inpatient authorization requests (PDF)
Pilot program with TurningPoint supports members’ musculoskeletal care (PDF)
Danyelza™, Margenza® and Saphnelo™ to require prior authorization for URMBT members with Blue Cross non-Medicare plans (PDF)
AIM authorization IDs to include alpha characters starting in April (PDF)
March 2022
Availity® administrators: Set up the e-referral tool within Availity (PDF)
Carvykti™ and Byooviz™ to require prior authorization for commercial members (PDF)
Blue Cross and BCN information now available within Availity Essentials (PDF)
TurningPoint coding requirements for musculoskeletal procedures and related services (PDF)
Update on e-referral news items display
Update: We'll stop accepting faxed requests for commercial SNF admissions starting June 1
Brineura® won’t require prior authorization for URMBT members with Blue Cross non-Medicare plans
Enjaymo™ will have prior authorization and site-of-care requirements for commercial members, starting March 17
Behavioral health resources to discuss with your patients
Kimmtrak® and Tivdak® to require prior authorization for most members starting May 23
e-referral system out of service for maintenance overnight March 19-20
Carvykti™ to require prior authorization for Medicare Advantage members starting March 7
Reminder: Starting March 1, we aligned our Local Rules for acute inpatient medical admissions
Empaveli® and Actemra® to require prior authorization for Blue Cross URMBT non-Medicare members, starting June 1
We're ending the temporary suspension of clinical review requirements for admission to skilled nursing facilities
Outpatient PT, OT services no longer require prior authorization for Medicare Plus BlueSM, starting April 1
We're postponing the authorization requirement for *71271 for BCN members
February 2022
Musculoskeletal procedure authorizations: Reminders for facilities
Submit prior authorization requests for prescription drugs through an ePA tool to avoid processing delays
Enjaymo™, Vabysmo™ and Byooviz® to require prior authorization for Medicare Advantage members
New Mobile cardiac outpatient telemetry questionnaire to open in the e-referral system, starting Feb. 27
CareCentrix HIPPS Questionnaire updates targeted for April for Medicare Plus BlueSM members who receive home health services in Michigan
Nyvepria™ and Rybrevant™ to require prior authorization for UAW Retiree Medical Benefits Trust members with Blue Cross non-Medicare plans starting May 16
Leqvio®, Tezspire™ and Vabysmo™ to require prior authorization for commercial members starting in February
e-referral system out >e-referral system out of service for maintenance overnight Feb. 19-20
On Feb. 18, the Utilization Management call center at 1-800-392-2512 will be closed until 1 p.m.
e-referral system unavailable overnight Feb. 11-12
TurningPoint authorizations for musculoskeletal surgical and related procedures are valid for six months
January 2022
Update: Temporary suspension of clinical review requirements continues for admission to skilled nursing facilities from hospitals in certain states
Avsola® and Inflectra® will be the preferred infliximab products for commercial members, starting April 1
Vyvgart™ will have prior authorization and site-of-care requirements for commercial members, starting Jan. 13
Advantages of using the e-referral system for prior authorization requests instead of calling or faxing
