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April 2024

Amtagvi will have additional requirements for most commercial members, starting May 28 (PDF)

Winrevair SQ to require prior authorization for most commercial members (PDF)

Procedure codes that require prior authorization through BCN (PDF)

Cosentyx IV to have a site-of-care requirement for most commercial members starting July 1 (PDF)

Winrevair to require prior authorization for Medicare Advantage members starting May 1 (PDF)

Vyjuvek to have a site-of-care requirement for most commercial members starting April 4 (PDF)

March 2024

Questionnaire changes in the e-referral system starting March 31 (PDF)

Cinryze, Elfabrio and Evkeeza to have a site-of-care requirement for most commercial members starting July 1 (PDF)

Columvi, Daxxify and Qalsody to require prior authorization for URMBT members with Blue Cross non-Medicare plans (PDF)

March 29 holiday closure: How to submit authorization requests for inpatient admissions (PDF)

Lenmeldy to require prior authorization for most commercial members starting March 28 (PDF)

Step therapy requirement to be added for VPRIV and Elelyso for Medicare Advantage members starting June 1 (PDF)

Tofidence will require prior authorization for Medicare Advantage members starting May 1 (PDF)

Elrexfio and Talvey to require prior authorization for most members starting June 20 (PDF)

Explanation of lifestyle modification for weight loss drugs (PDF)

Wyost SC, Jubbonti SC and Tyenne IV and SC to require prior authorization for most commercial members starting March 21 (PDF)

e-referral system out of service for maintenance overnight March 16-17 (PDF)

Update: Preferred product for Zynteglo for most commercial members starting April 19 (PDF)

Udenyca Onbody to require prior authorization for most commercial members effective immediately (PDF)

Update: Prior authorization requirements are changing for musculoskeletal pain management and spinal procedure codes (PDF)

We’re changing how we manage Entyvio SC and Omvoh SC, starting March 1 (PDF)

Additional drugs to require prior authorization for Medicare Advantage members starting April 1 (PDF)

February 2024

Medicare Plus Blue PPO Provider Manual update coming in April 2024 (PDF)

Update: Prior authorization requests for behavioral health services (PDF)

Changes to the Gastric stimulation and Breast reconstruction questionnaires in the e-referral system (PDF)

Update: Amtagvi to require prior authorization for most commercial members starting Feb. 29 (PDF)

Additional preferred products for Soliris and Ultomiris for most commercial members starting April 1 (PDF)

e-referral system out of service for maintenance overnight Feb. 17-18 (PDF)

Don’t submit referrals for members with BCN point-of-service plans (PDF)

Additional cardiology services to require prior authorization through Carelon for commercial members, starting May 11 (PDF)

Call Blue Cross Behavioral Health if you need additional ABA units to bill approved authorizations (PDF)

January 2024

Starting in March, we’ll no longer attach approval letters to Blue Cross commercial inpatient authorizations (PDF)

We’re no longer mailing some letters related to Medicare Advantage inpatient admissions (PDF)

Pemfexy to have step therapy requirements starting April 26 (PDF)

Omvoh to have a site-of-care requirement for most commercial members starting May 1 (PDF)

Include complete clinical information when submitting prior authorization requests for weight loss drugs (PDF)

Updated: Entyvio, Omvoh and Wezlana to require prior authorization for most commercial members (PDF)

Questionnaire changes in e-referral starting Jan. 28 (PDF)

In the Blue Cross Behavioral Health provider portal, complete only the required fields when searching for a member (PDF)

Starting March 1, some continuous glucose monitor products will require prior authorization (PDF)

Updated: Alyglo to require prior authorization for most commercial members starting Jan. 18 (PDF)

Cabenuva to have requirements for most commercial members starting May 1 (PDF)

Email us if you’re having technical problems using the Blue Cross Behavioral Health provider portal (PDF)

e-referral system out of service for maintenance overnight Jan. 20-21 (PDF)

Continuity of care arrangements are expanded to Medicare Advantage members (PDF)

Requirements changing for some medical benefit drugs for Medicare Advantage members (PDF)

Blue Cross Behavioral Health to reinstate requirements; providers can submit authorization requests (PDF)

January 2, 2024: Changes to ereferrals.bcbsm.com (PDF)

Jan. 15 holiday closure: How to submit authorization requests for inpatient admissions (PDF)



December 2023

December 28, 2023: Changes to ereferrals.bcbsm.com (PDF)

December 5, 2023: Changes to ereferrals.bcbsm.com (PDF)

NaviHealth to change its name to Home & Community Care (PDF)

Updated: Two changes for the services managed by Blue Cross Behavioral Health (PDF)

Avzivi and Ryzneuta to require prior authorization for most commercial members starting Jan. 1 (PDF)

Casgevy and Lyfgenia to require prior authorization for Medicare Advantage members starting Jan. 2 (PDF)

December-January holiday closures: How to submit authorization requests for inpatient admissions (PDF)

Updated: Don’t submit prior authorization requests to Blue Cross Behavioral Health for dates of service on or after Jan. 1, until further notice (PDF)

Prior authorization requests for Makena for Federal Employee Program members (PDF)

Changes to Computed tomography to detect coronary artery calcification questionnaires in the e-referral system on Dec. 17 (PDF)

Additional drugs to require prior authorization for Federal Employee Program non-Medicare members starting April 1 (PDF)

Rystiggo to have a site-of-care requirement for most commercial members starting April 1 (PDF)

Casgevy and Lyfgenia to require prior authorization for most commercial members (PDF)

We follow CMS guidelines and evidence-based criteria when reviewing inpatient admission requests (PDF)

Changes to the Medical formula for inborn errors of metabolism questionnaire in the e-referral system (PDF)

Letters to providers will include reason BCN admissions were bundled (PDF)

Additional drugs to have site-of-care requirements for some Blue Cross commercial members, starting March 15 (PDF)

e-referral system out of service for maintenance overnight Dec. 16-17 (PDF)

New labor contract ratified by UAW at Blue Cross Blue Shield of Michigan and Blue Care Network (PDF)

Updated: Blue Cross continues to pay claims during our union represented employee work stoppage at Blue Cross (PDF)

Medicare Advantage provider servicing wait times (PDF)

Updated Requirements for providing behavioral health services to Blue Cross commercial members document will be available in January (PDF)

Additional drugs to require prior authorization for Federal Employee Program non-Medicare members starting March 1 (PDF)

Step therapy requirement to be added for Soliris and Ultomiris for Medicare Advantage member (PDF)

Additional drugs to have requirements for URMBT members with Blue Cross non-Medicare plans (PDF)

November 2023

Update: Additional medical oncology drugs to have requirements for most members (PDF)

How autism treatment authorizations will continue into 2024 (PDF)

Reminder: Document the need for a continuous glucose monitoring device in the member’s medical record for continued coverage (PDF)

How to submit clinical information to Carelon when requesting prior authorization (PDF)

Questionnaires changes in the e-referral system starting Nov. 26 (PDF)

Nov. 23-24 holiday closure: How to submit inpatient authorization requests (PDF)

Adzynma to require prior authorization for most commercial members (PDF)

Additional drugs to require prior authorization for Medicare Advantage members starting Feb. 12 (PDF)

e-referral system out of service for maintenance overnight Nov. 18-19 (PDF)

Updated: Entyvio, Omvoh and Wezlana to require prior authorization for most commercial members (PDF)

November 10, 2023: Changes to ereferrals.bcbsm.com (PDF)

Update: Kidney-only transplants to require prior authorization through the Human Organ Transplant Program, starting Jan. 1 (PDF)

Solid organ and bone marrow transplants won’t require prior authorization for BCN Advantage members, starting Jan. 1 (PDF)

Changes to prior authorization request process for varicose vein procedures (PDF)

New and updated questionnaires in e-referral system starting Nov. 5 (PDF)

More information about the Jan. 1 behavioral health changes (PDF)

Omisirge to require prior authorization for Medicare Advantage members starting Feb. 1 (PDF)

October 2023

October 24, 2023: Changes to ereferrals.bcbsm.com (PDF)

October 12, 2023: Changes to ereferrals.bcbsm.com (PDF)

Cosentyx IV to require prior authorization for most commercial members (PDF)

Changes to infliximab step therapy requirements for Medicare Advantage members (PDF)

Updated: For commercial LTACH requests, questionnaire will open in e-referral system (PDF)

Tecvayli will have additional requirements for most commercial members, starting Dec. 7 (PDF)

Update: Changes to preferred drug designations and prior authorization requirements for Medicare Advantage members (PDF)

We’ll use updated 2023 InterQual criteria starting Feb. 1 (PDF)

Update: Beyfortus will have limits for commercial members, starting Jan. 1 (PDF)

e-referral system out of service for maintenance overnight Oct. 21-22 (PDF)

Carelon won’t manage home sleep studies starting Jan. 1 (PDF)

Syfovre and Izervay must not be used with other geographic atrophy drugs for commercial members, starting Nov. 24 (PDF)

Pombiliti, Rivfloza and Tofidence to require prior authorization for most commercial members (PDF)

Updated questionnaires in the e-referral system starting Oct. 15 (PDF)

Upcoming changes to the TurningPoint provider portal (PDF)

Vyvgart Hytrulo to have a site-of-care requirement for most commercial members starting Jan. 1 (PDF)

Updated reminder: Changes for in-lab sleep studies to start Oct. 9 (PDF)

September 2023

Changes to preferred drug designations under the medical benefit for most commercial members, starting Jan. 1 (PDF)

Management of outpatient diabetes supplies for additional members starting Jan. 1 (PDF)

Some diabetes drugs to require prior authorization for Blue Cross and BCN members, starting Jan. 1 (PDF)

Reminder: Facilities must submit appeals within the required time frames (PDF)

Reminder: Additional services require prior authorization through Carelon (PDF)

Starting Oct. 1, 2023, we’ll change prior authorization criteria for some weight loss drugs (PDF)

New and updated questionnaires in the e-referral system starting Sept. 24 (PDF)

Prior authorization no longer required for some procedures, starting Jan. 1 (PDF)

Daxxify to require prior authorization for Medicare Advantage members starting Dec. 18 (PDF)

Update: New and updated TurningPoint medical policies for musculoskeletal and pain management procedures (PDF)

e-referral system out of service for maintenance overnight Sept. 16-17 (PDF)

Zynyz to require prior authorization for most members starting Dec. 10 (PDF)

Lumoxiti will no longer require prior authorization starting Sept. 30 (PDF)

Update: Advance notice requirements for noncovered services by independent and hospital labs (PDF)

Updated Orthoptic and pleoptic visual training questionnaire in e-referral system (PDF)

Tyruko to require prior authorization for most commercial members starting Sept. 14 (PDF)

August 2023

Medicare Plus BlueSM PPO Provider Manual update coming in October 2023 (PDF)

Look for a status note in e-referral system when we pend prior authorization requests for some services (PDF)

Veopoz, Eylea HD and Daxxify to require prior authorization for most commercial members (PDF)

Sept. 4 holiday closure: How to submit inpatient authorization requests (PDF)

Additional drugs to require prior authorization for Medicare Advantage members starting Oct. 15 (PDF)

Prior authorization changes for varicose vein treatments (PDF)

New and updated questionnaires in the e-referral system starting Aug. 27 (PDF)

Requirements for prior authorization of Omisirge (PDF)

Lantidra and Rethymic to require prior authorization for most commercial members (PDF)

Starting Sept. 1, we’ll require prior authorization for some diabetes drugs (PDF)

Izervay to require prior authorization for most commercial members (PDF)

e-referral system out of service for maintenance overnight Aug. 19-20 (PDF)

July 2023

Update: Changes for in-lab sleep studies to start Oct. 9 (PDF)

Updated questionnaires in the e-referral system (PDF)

For commercial LTACH requests, submit information about three SNFs to avoid delays (PDF)

Rystiggo® and Vyvgart® Hytrulo to require prior authorization for most commercial members (PDF)

Starting Sept. 1, 2023, we’ll change prior authorization requirements for some weight loss drugs (PDF)

e-referral system out of service for maintenance overnight July 15-16 (PDF)

Additional drugs to require prior authorization for Medicare Advantage members starting July 10 (PDF)

Elevidys and RoctavianTM to require prior authorization for most commercial members starting July 6 (PDF)