Access & Training
BCN
Authorizations / Referrals
- Authorization Requirements & Criteria
(formerly Clinical Review & Criteria
Charts) - Provider Manual Chapters
- AIM-Managed Procedures
- Autism
- Bariatric Surgery
- Behavioral Health
- eviCore-Managed Procedures
- Forms
- Medical Benefit Drugs – Pharmacy
- MSU Health Plans
- Musculoskeletal Services
- Outpatient PT, OT, ST
- Sleep Management Program
- Spine Care Referral Program
Additional Resources
Providers must obtain authorizations for select musculoskeletal services.
Blue Cross and BCN Utilization Management departments
Blue Cross and BCN Utilization Management departments
For dates of service before June 1, 2020, the Blue Cross and BCN Utilization Management departments manage authorizations for the following procedures and members:
- Joint procedures for Medicare Plus BlueSM PPO, BCN HMOSM and BCN AdvantageSM members
- Spine procedures for BCN HMO and BCN Advantage members
eviCore healthcare®
For all dates of service, providers must obtain authorization from eviCore for inpatient and outpatient lumbar spinal fusion surgery for the following members:
- Blue Cross PPO (commercial) - For all fully insured groups except Michigan Education Special Services Association
- Medicare Plus Blue PPO
Refer to the following resources for more information:
- Procedures that require authorization by eviCore healthcare (PDF) - List of procedure codes for which eviCore manages authorizations
- Guidelines for services reviewed by eviCore healthcare for Medicare Plus BlueSM PPO and Blue Care Network (PDF) - How to handle different types of authorization requests
For information about other services managed by eviCore, see the Blue Cross eviCore-Managed Procedures page or the BCN eviCore-Managed Procedures page.
TurningPoint Healthcare Solutions, LLC
TurningPoint Healthcare Solutions, LLC
For dates of service on and after June 1, 2020, providers must obtain authorization from TurningPoint for the following procedures and members:
- Joint procedures for Medicare Plus Blue, BCN HMO and BCN Advantage members
- Spine procedures for BCN HMO and BCN Advantage members
Refer to the following resources for more information:
- Orthopedic procedure codes that require authorization by TurningPoint for Medicare Plus Blue, BCN HMO and BCN Advantage members (PDF)
- Spinal procedure codes that require authorization by TurningPoint for BCN HMO and BCN Advantage members (PDF)
- Musculoskeletal procedure authorizations: Frequently asked questions for providers (PDF)
- Musculoskeletal procedure authorizations: Quick reference for providers (PDF)
- TurningPoint Provider Training Manual (PDF)