Blue Care Network provides materials and resources to assist you with your behavioral health referrals. In addition to the information listed on this page, you can access the complete version of the BCN Provider Manual and other behavioral health resources including the BCN Behavioral Health Fee Schedule on web-DENIS in BCN Provider Publications and Resources.
Thank you to those who completed the Behavioral Health Quality Improvement Program Survey. The survey completion period has ended. Please watch for more information about BCN's new behavioral health quality improvement program in BCN Provider News.
Forms for requesting clinical review
Utilization management criteria (effective Jan. 1, 2016)
InterQual®. BCN Behavioral Health uses McKesson's InterQual Behavioral Health Criteria as utilization management guidelines. Providers may request a copy of the specific InterQual criteria used to render a decision on a member's case. Providers who wish to purchase the InterQual Behavioral Health criteria in their entirety may do so at a discounted rate by emailing McKesson at InterQualBHCriteriaBlueCareNetwork@McKesson.com.
Local criteria. In addition, BCN Behavioral Health uses its own, local utilization management criteria for decisions about the following services:
- Transcranial magnetic stimulation
- Neurofeedback training for attention deficit disorder / attention deficit hyperactivity disorder
- Autism spectrum disorder / applied behavior analysis
- Residential mental health services (adult, adolescent and child)
Additional information. For more information about BCN's behavioral health utilization management criteria.
Medical record documentation requirements
- Behavioral health screening tools
- Useful tools and hints for BCN behavioral health providers (PDF)
- Behavioral Health e-referral User Guide (PDF)
- Submitting authorization requests through e-referral - FAQ (PDF)
- BCN Provider Manual — Behavioral Health chapter (PDF)
- Instructions for filling out CMS-1500 form (02/12) (PDF)
- Requirements for providing behavioral health services to BCN members (PDF)
- Licensed Professional Counselors — Introduction to Blue Cross and Blue Care Network (PDF)
- Depression tip sheet (PDF)
- Depression office poster (PDF)
- Depression brochure for members (PDF)
- Provider Inquiry Contact Information
Call for general assistance with behavioral health services, including:
- Assistance in arranging services
- Request authorization for services
- Discuss or receive information on criteria used to render an authorization decision
- Claims inquiries
The only exceptions are for prior authorization for psychological assessment prior to bariatric surgery and authorization for acute detoxification services. For these situations call 1-800-392-2512.
- BCN Behavioral Health Provider Outreach assistance
Go to the Provider contact us section of bcbsm.com to locate contact information for assistance with the following:
- Enrollment and credentialing questions
- Contractual issues
- Recurring problems or unresolved issues
- Education and training assistance on BCN policies, procedures and programs