• Summary of utilization management programs for Michigan providers (PDF)
• BCN Referral and Authorization Requirements (PDF)
• About Blue Dot Changes to the BCN Referral and Authorization Requirements document (PDF)
• Procedures codes that require authorization by BCN (PDF)
• Acute inpatient care
• Summary of utilization management programs for Inpatient Acute Hospital Medical Admissions (PDF)
• Acute inpatient admission requests: Guidelines for submitting to BCN (PDF)
• Acute inpatient admission requests: Request for Review of Initial Inpatient Admission form (PDF)
• Post-acute care:
• For BCN HMO members admitted at any time and for BCN Advantage members admitted through May 31, 2019 – Post-acute care admissions: Submitting authorization requests to BCN (PDF)
• For BCN Advantage members admitted on or after June 1, 2019 – Post-acute care services: Frequently asked questions by providers (PDF)
• Air ambulance authorization requests for BCN HMO^SM (commercial) members:
• Air ambulance flight information (non-emergency) form (PDF)
• Air ambulance initiative: Description (PDF)
• BCN's Local Rules effective Aug. 1, 2019 (PDF)
• BCN Criteria Request Form (for non-behavioral health cases) (PDF)
• Peer-to-peer reviews:
• How to request a peer-to-peer review with a Blue Cross or BCN medical director (PDF)
• Physician peer-to-peer-request form (for non-behavioral health cases) (PDF)

Authorization criteria and preview questionnaires

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.