Providers must obtain authorization from Carelon Medical Benefits Management (formerly AIM Specialty Health^®) for:

• Select cardiology and radiology services including cardiac implantable devices and services
• Medical oncology and supportive care drugs for BCN commercial and BCN Advantage members

Prior authorization requirements for cardiology and radiology services apply to services performed in the following settings:

• Freestanding diagnostic facilities
• Outpatient hospital settings
• Ambulatory surgery centers
• Physician offices

When cardiology and radiology services are performed in an observation, emergency or inpatient care setting, they don't require authorization.

How to submit prior authorization requests

Submit prior authorization requests to Carelon as follows.

• For commercial members, Michigan’s prior authorization law* requires health care providers to submit prior authorization requests electronically. Alternate submission methods (phone) are allowed in the case of temporary technological problems, such as power or internet outages.
• For Medicare Advantage members, submit requests using any of the methods below.

You can access the Carelon ProviderPortal:

• Through our provider portal:
1. Log in to our provider portal (availity.com*).
2. Click Payer Spaces on the menu bar and then click the BCBSM and BCN logo.
3. Click the Carelon ProviderPortal tile on the Applications tab.
• By logging in directly to the Carelon ProviderPortal^®*

You can also call Carelon at 1-844-377-1278

Requests should be submitted before the services are provided.

Resources - cardiology and radiology

• Procedures that require prior authorization by Carelon: Cardiology, radiation oncology, radiology (high technology) and sleep studies (in lab) (PDF)
• Frequently asked questions about Carelon: for cardiology, radiology (high technology) and sleep studies (in lab) (PDF) - Answers to some questions about authorization requirements for cardiology and radiology (high technology) services
• Cardiology: For home monitoring and cardiology and echocardiology procedures (PDF) - Includes information about care management and utilization management programs
• Oncology: For CAR-T cell therapy, medical oncology and radiation oncology (PDF) - Includes information about utilization management programs
• Radiology procedures (high-tech imaging): For authorization determinations (PDF) - Includes information about utilization management programs

Resources - medical oncology

• Medical oncology prior authorization list for Blue Cross and BCN commercial members: Medications that require authorization by Carelon (PDF) - A list of drugs and codes that require authorization through Carelon for Blue Cross commercial and BCN commercial members
• Medical oncology and supportive care drugs that require authorization by Carelon for Medicare Advantage members (PDF) - A list of drugs and codes that require prior authorization, including those managed by Carelon for BCN Advantage and Medicare Plus Blue members
• Oncology management program: Frequently asked questions for providers (PDF) - Questions and answers about the oncology management program
• Carelon Oncology Management Program resources* - A Carelon webpage providing Cancer Treatment Pathways worksheets, prior authorization requirements and other resources that help providers compare planned cancer treatment regimens against evidence-based regimens that align with BCN and Blue Cross medical policy.
• Drugs: For medication adherence, medical benefit drugs and pharmacy benefit drugs (PDF)
• Oncology: For CAR-T cell therapy, medical oncology and radiation oncology (PDF) - Includes information about utilization management programs

*Clicking this link means that you're leaving the Blue Cross Blue Shield of Michigan and Blue Care Network website. While we recommend this site, we're not responsible for its content.

Availity^® is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to offer provider portal and electronic data interchange services.