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December 2023

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

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

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)

Entyvio, Omvoh and Wezlana to require prior authorization for most commercial members (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 Blue^SM 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 Roctavian^TM to require prior authorization for most commercial members starting July 6 (PDF)

June 2023

Submit prior authorization requests for non-emergency air ambulance flights through the Alacura PreAuth Portal (PDF)

July 3-4 holiday closure: How to submit inpatient authorization requests (PDF)

Updated Septoplasty and Blepharoplasty questionnaires in the e-referral system (PDF)

June 19 holiday closure: How to submit inpatient authorization requests (PDF)

How Blue Cross and BCN are handling authorizations for Makena^® following FDA announcement (PDF)

Updated Left atrial appendage closure questionnaires in the e-referral system (PDF)

Reminder: Register for a webinar on June 15 or 21 to learn how to submit requests for ABA services through e-referral (PDF)

Elfabrio^® and Vyjuvek^™ to require prior authorization for Medicare Advantage members starting Aug. 14 (PDF)

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)

Elahere^TM, Imjudo^®, Tecvayli^TM, Lunsumio^TM to require prior authorization for most members starting Aug. 23 (PDF)

Clarification: Xgeva^® continues to require prior authorization through NovoLogix^® 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)

Qalsody^TM 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)

Register now for training on how to submit LTACH prior authorization requests through the e-referral system (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)

Qalsody^TM 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

Updated Experimental and investigational services questionnaire in the e-referral system starting May 1 (PDF)

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)

Blue Cross and BCN to use Audaire Health^TM provider portal to capture clinical outcomes for CAR-T cell therapy drugs (PDF)

Changes to maternity support program and new menopause support program (PDF)

Updated questionnaire in the e-referral system (PDF)

Tzield^TM 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)

Rolvedon^TM 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)

Jemperli and Opdualag^TM to have site-of-care requirements for BCN commercial members starting July 1 (PDF)

Starting June 1, requests for commercial LTACH admissions and extensions must be submitted through e-referral and not by fax (PDF)

Briumvi^TM 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)

Transfer Medicare Advantage members to post-acute care facilities immediately after appeals are approved (PDF)

Updated: Prior authorization changes coming in June (PDF)

Starting June 1, submit prior authorization requests for human organ transplants through e-referral and not by fax (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)

Cimerli^TM and Xenpozyme^TM to require prior authorization for URMBT members with Blue Cross non-Medicare plans (PDF)

Questionnaires available again in the e-referral system (PDF)

AIM ProviderPortal operating slowly (PDF)

January 2023

Transfer Medicare Advantage members to post-acute care facilities immediately after appeals are approved (PDF)

Rebyota^TM to require prior authorization for Medicare Advantage members starting March 1 (PDF)

Adstiladrin^® and Stimufend^® to require prior authorization for most commercial members starting Feb. 2 (PDF)

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

Briumvi^TM and Leqembi^TM to require prior authorization for most commercial members starting Jan. 26 (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)

Reminder: Assessments and clinical documentation to submit for services received by Medicare Advantage members in SNFs (PDF)

Jan. 16 holiday closure: How to submit inpatient authorization requests (PDF)

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

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