Access & Training
BCN
Authorizations / Referrals
- Authorization Requirements & Criteria
- Provider Manual Chapters
- AIM-Managed Procedures
- Autism
- Bariatric Surgery
- Behavioral Health
- Blue Elect Plus POS
- eviCore-Managed Procedures
- Forms
- Medical Benefit Drugs
- MSU Health Plans
- Musculoskeletal Services
- Outpatient PT, OT, ST
- Pharmacy Benefit Drugs
- Sleep Management Program
- Spine Care Referral Program
Additional Resources
Below are links to various utilization-management-related forms, some of which are used to request authorization for various services. These forms are also available, along with others, on BCN's Forms page within Provider Secured Services. To access the complete Forms Library, log in to Provider Secured Services, click BCN Provider Publications and Resources and then click Forms.
Bariatric surgery
BCN AdvantageSM
Skilled nursing facilities and home health agencies
- Medicare regulations (PDF) (See sections 90.2 through 90.5)
- CMS Beneficiary Notices information
Hospitals, for patients in observation
Hospitals, for inpatients
Noncontracted providers
- Waiver of Liability (PDF)
Member form
- Patient Assessment Form (PDF)
Behavioral health services
Drugs covered under the medical benefit
For information about drugs covered under the medical benefit, visit the Medical Benefit Drugs – Pharmacy page on this website.
e-referral
Transitional care services
- LTACH Assessment Form (PDF) – for BCN HMO members admitted anytime and for BCN Advantage members admitted through May 31, 2019
- Rehabilitation Assessment Form (PDF) – for faxing rehabilitation and SNF requests BCN HMO members admitted anytime and for BCN Advantage members admitted through May 31, 2019
- Skilled nursing facility assessment form (PDF) – for attaching to the case in the e-referral system starting Dec. 1, 2020, for Blue Care Network commercial members
Note: For BCN Advantage members admitted to post-acute care on or after June 1, 2019, see Post-acute care services: Frequently asked questions by providers (PDF).