Authorization Requirements & Criteria

Important information during the coronavirus (COVID-19) pandemic

For temporary changes and recommendations for providers, refer to our COVID-19 provider webpage

Find more information for providers:

  1. Log in to our provider portal (availity.com)*.
  2. Click Payer Spaces on the Availity menu bar.
  3. Click the BCBSM and BCN logo.
  4. Click Secure Provider Resources (Blue Cross and BCN) on the Resources tab.
  5. Click Coronavirus on the Member Care tab.

This page provides Blue Cross Blue Shield of Michigan's prior authorization requirements, including information that applies to:

For both Blue Cross commercial and Medicare Plus Blue members

Utilization management criteria – Blue Cross commercial and Medicare Plus Blue

Forms – Blue Cross commercial and Medicare Plus Blue

For Blue Cross commercial members

Information on requesting authorization – Blue Cross commercial

Utilization management criteria – Blue Cross commercial

Forms – Blue Cross commercial

Air ambulance authorization requests – Blue Cross commercial

Blue Cross PPO (commercial) Provider Manual

To access the manual, complete these steps:

  1. Log in to our provider portal (availity.com)*.
  2. Click Payer Spaces on the Availity menu bar.
  3. Click the BCBSM and BCN logo.
  4. Click Provider Manuals on the Resources tab.
  5. Click Blue Cross commercial.

For Medicare Plus Blue members

Services that require authorization – Medicare Plus Blue

Forms – Medicare Plus Blue

Authorization criteria and preview questionnaires – Medicare Plus Blue

We use our authorization criteria or our medical policies to make determinations on prior authorization requests for select services. To determine which services have authorization criteria and view authorization criteria and preview questionnaires, see the Authorization criteria and preview questionnaires (PDF).

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