Authorization Requirements & Criteria

Important information during the coronavirus (COVID-19) pandemic

Temporary changes and recommendations for providers:

Find more information for providers:

  1. Log in as a provider at bcbsm.com/providers.
  2. Click the special notice at the top of the Provider Secured Services home page.

Below are links to documents detailing Blue Care Network's authorization and referral requirements; lists of procedures that require authorization; and authorization criteria and preview questionnaires for various procedures. These apply to services other than drugs covered under the medical benefit. In addition, there are links to Pediatric Choice and Woman's Choice program information.

For drugs covered under the medical benefit, visit the Drugs Covered Under the Medical Benefit page in the BCN section of this website.

For Blue Cross Complete utilization management information, go to MiBlueCrossComplete.com/providers.

Referral and authorization information

Authorization criteria and preview questionnaires

The following documents pertain to procedures for which the BCN Utilization Management department manages authorizations for dates of service prior to July 1, 2020.

For dates of service on or after July 1, 2020, TurningPoint Healthcare Solutions, LLC manages authorization requests. You can submit authorization requests to TurningPoint starting on June 1, 2020. See the Musculoskeletal Services page for more information.

Pediatric Choice

Woman's Choice

The Woman's Choice program allows BCN members to directly access affiliated physicians who perform obstetric or gynecologic services. In line with Woman's Choice guidelines, an obstetrician-gynecologist may perform or order some services without a referral from the primary care physician.