Providers must obtain prior authorization from eviCore® healthcare for:
- Outpatient physical, occupational and speech therapy services (by therapists) for BCN commercial and BCN AdvantageSM members when delivered by independent physical therapists, outpatient therapy providers, physician practices and hospital-based outpatient therapy centers
- Physical medicine services by chiropractors and by athletic trainers for BCN commercial members only
Submit prior authorization requests for both initial and follow-up visits to eviCore 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 eviCore provider portal:
- Through our provider portal:
- Log in to our provider portal (availity.com*).
- Click Payer Spaces on the menu bar and then click the BCBSM and BCN logo.
- Click the eviCore Provider Portal tile on the Applications tab.
You can also call eviCore at 1-855-774-1317
For additional information on the utilization management requirements for these services, refer to the Utilization Management chapter of the BCN Provider Manual. Look in the section titled "Managing PT, OT and ST / Managing physical medicine services."
These utilization management requirements don’t apply to members with BCN 65 plan coverage or to the treatment of autism spectrum disorders for members 18 years of age and younger.
Resources for managing therapy and physical medicine services
- Procedure codes that require authorization by eviCore healthcare (PDF)
- Services reviewed by eviCore for Blue Cross and BCN (PDF)
- Outpatient rehabilitation services: Frequently asked questions (PDF)
- BCN implementation page on the eviCore website*
- Understanding your BCN coverage for different therapy / physical medicine services (PDF)
- Tips about eviCore Authorizations for BCN Members (PDF)
- Suggestions for the Efficient Utilization of Therapy and Physical Medicine Services (PDF)
- Tips for improving treatment efficiency (PDF)
- FAQs: Practitioner Performance Summary and Provider Categories* (PDF)
- Chiropractic services: For chiropractic manipulations and physical medicine services by chiropractors (PDF) - Includes information about utilization management programs
- Outpatient PT, OT and ST, and physical medicine services by chiropractors and athletic trainers: For authorization determinations (PDF) - Includes information about utilization management programs
- U-M Premier Care Primary (Major) Diagnosis Codes for Therapies (PDF)
See also BCN's eviCore-Managed Procedures page on this website.
*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.