
June 2023
e-referral user guides updated (PDF)
Carelon to expand existing prior authorization program starting Sept. 1 (PDF)
We’ll use 2023 InterQual® criteria starting Aug. 1 (PDF)
May 2023
Vyjuvek™ to require prior authorization for most commercial members (PDF)
Elfabrio® and Omisirge® to require prior authorization for most commercial members (PDF)
e-referral system unavailable on three May-June weekends (PDF)
QalsodyTM to require prior authorization for Medicare Advantage members starting Aug. 1 (PDF)
Updated questionnaires in the e-referral system, starting May 14 (PDF)
Updated medical record documentation guidelines for musculoskeletal procedures (PDF)
Learn how to submit requests for ABA services through e-referral (PDF)
Updates to list of musculoskeletal procedure codes that require prior authorization (PDF)
QalsodyTM to require prior authorization for most commercial members (PDF)
Some pre-COVID-19 utilization management requirements to resume July 1 (PDF)
e-referral system out of service on two weekends in May (PDF)
April 2023
Starting June 1, submit prior authorization requests for ABA services through e-referral (PDF)
Quartet Care Navigation Platform: FAQ for behavioral health providers is available (PDF)
Updated questionnaires in the e-referral system, starting April 24 (PDF)
Changes to maternity support program and new menopause support program (PDF)
Updated questionnaire in the e-referral system (PDF)
TzieldTM to require prior authorization for URMBT members with Blue Cross non-Medicare plans (PDF)
e-referral system out of service for maintenance overnight April 15-16 (PDF)
March 2023
April 7 holiday closure: How to submit inpatient authorization requests (PDF)
RolvedonTM will have requirements for URMBT members with Blue Cross non-Medicare plans (PDF)
Prior authorization processes for MESSA members changing June 1 (PDF)
AIM to change its name to Carelon (PDF)
Questionnaire changes in the e-referral system (PDF)
Lamzede® to require prior authorization for Medicare Advantage members starting May 1 (PDF)
BriumviTM to have a site-of-care requirement for most commercial members starting July 1 (PDF)
e-referral system out of service for maintenance overnight March 18-19 (PDF)
Resources for members coping with the MSU tragedy (PDF)
Changes to Carelon’s (formerly AIM’s) provider portal for medical oncology program (PDF)
Updated: Prior authorization changes coming in June (PDF)
Members may call about colorectal cancer screening (PDF)
February 2023
Determining prior authorization requirements for patients with non-Michigan Blue plans (PDF)
Lamzede, Syfovre™ and Vegzelma® to require prior authorization for most commercial members (PDF)
Syfovre™ to require prior authorization for Medicare Advantage members starting April 3 (PDF)
Behavioral health resources needed for members (PDF)
e-referral system out of service for maintenance overnight Feb. 18-19 (PDF)
Adstiladrin® to require prior authorization for Medicare Advantage members starting May 1 (PDF)
Questionnaires available again in the e-referral system (PDF)
AIM ProviderPortal operating slowly (PDF)
January 2023
RebyotaTM to require prior authorization for Medicare Advantage members starting March 1 (PDF)
e-referral system out of service for maintenance overnight Jan. 21-22 (PDF)
Byooviz® is no longer the preferred ranibizumab drug for Medicare Advantage members (PDF)
Leqembi™ to require prior authorization for Medicare Advantage members starting Jan. 13 (PDF)
Jan. 16 holiday closure: How to submit inpatient authorization requests (PDF)
December 2022
Assisted reproductive technology benefit expanded, starting Jan. 1. 2023 (PDF)
BCN to use updated InterQual® ABA criteria starting March 1 (PDF)
Cognitive rehabilitation questionnaire to be removed from e-referral system on Dec. 18 (PDF)
Questionnaires to be removed from e-referral system on Dec. 18 (PDF)
RebyotaTM to require prior authorization for most commercial members starting Jan. 5 (PDF)
December-January holiday closures: How to submit inpatient authorization requests (PDF)
e-referral system out of service for maintenance overnight Dec. 17-18 (PDF)
Hemgenix® and TzieldTM to require prior authorization for most members starting in December (PDF)
November 2022
New and updated questionnaires in the e-referral system starting Nov. 27 (PDF)
Outpatient ECT won’t require prior authorization for BCN members, starting Jan. 1 (PDF)
Nov. 24-25 holiday closure: How to submit inpatient authorization requests (PDF)
Updated Gastric stimulation questionnaire in the e-referral system (PDF)
Fylnetra® to require prior authorization for Medicare Advantage members, starting Dec. 19 (PDF)
e-referral system out of service for maintenance overnight Nov. 19-20 (PDF)
Pemfexy® to require prior authorization for most members starting Feb. 9 (PDF)
Availity® Essentials services have been fully restored (PDF)
How to speed up the review process for AIM prior authorization requests (PDF)
October 2022
Nov. 8 holiday closure: How to submit inpatient authorization requests (PDF)
Updates related to swallow services for BCN (PDF)
Reimbursement for certified opioid treatment programs to change in 2023 (PDF)
e-referral system out of service for maintenance overnight Oct. 15-16 (PDF)
Skysona® to require prior authorization for most commercial members starting Oct. 20 (PDF)
September 2022
AIM ProviderPortal operating slowly (PDF)
Update: We’re changing how we manage biologic asthma therapies, starting Jan. 1 (PDF)
Issue now resolved: AIM ProviderPortal operating slowly (PDF)
e-referral training tools updated (PDF)
Spevigo® to require prior authorization for most commercial members starting Oct. 13 (PDF)
SNF outpatient therapies: How to submit prior authorization requests for BCN members (PDF)
Xenpozyme™ to require prior authorization for most commercial members, starting Oct. 6 (PDF)
Spevigo® to require prior authorization for Medicare Advantage members, starting Sept. 26 (PDF)
e-referral system out of service for maintenance overnight Sept. 17-18 (PDF)
CimerliTM to require prior authorization for Medicare Advantage members starting Oct. 3 (PDF)
Update: Updated questionnaires in the e-referral system starting Sept. 11 (PDF)
Zynteglo® to require prior authorization for most commercial members starting Sept. 22 (PDF)
More Medicare Advantage members to become eligible for Landmark Health’s in-home care program (PDF)
OpdualagTM to require prior authorization for most members starting Dec. 1 (PDF)
August 2022
Skyrizi® IV to have site-of-care requirement for most commercial members starting Dec. 1 (PDF)
September 5 holiday closure: How to submit inpatient authorization requests (PDF)
New and updated questionnaires in the e-referral system starting Aug. 28 (PDF)
CimerliTM to require prior authorization for most commercial members starting Sept. 1 (PDF)
Availity® administrators: Set up Health e-BlueSM tools within Availity (PDF)
Update: We’re changing how we manage biologic asthma therapies, starting Jan. 1 (PDF)
e-referral system out of service for maintenance overnight Aug. 20-21 (PDF)
Updated Vascular embolization or occlusion (TACE/RFA) questionnaire in the e-referral system (PDF)
We’re changing how we manage Skyrizi SC and Stelara SC, starting Aug. 15 (PDF)
Some members temporarily not found in AIM ProviderPortal® (PDF)
Releuko® to require prior authorization for most commercial members starting Nov. 1 (PDF)
Alymsys® to require prior authorization for most commercial members starting Aug. 25 (PDF)
BCN to use InterQual® ABA criteria for prior authorization requests submitted starting Oct. 1 (PDF)
July 2022
Due to supply shortages, patients shouldn't be started on Wegovy® (PDF)
Additional drugs will have requirements for URMBT members with Blue Cross non-Medicare plans (PDF)
Important information about billing and requesting prior authorization for denosumab (PDF)
Questionnaire changes in the e-referral system, starting July 25 (PDF)
e-referral system out of service for maintenance overnight July 16-17 (PDF)
Updated: Questionnaire changes in the e-referral system, starting July 10 (PDF)
Some SecureCare® clinical performance reports to be available later than expected (PDF)
Byooviz® to be the preferred ranibizumab drug for Medicare Advantage members starting Oct. 4 (PDF)