December 2024
Until Dec. 22, fax requests for prospective inpatient admissions with procedure code *99222 (PDF)
Yesintek to require prior authorization for most members (PDF)
More information about the Oncology Value Management program through OncoHealth (PDF)
November 2024
Questionnaires removed from the e-referral system on Nov. 24 (PDF)
Nov. 28-29 holiday closure: How to submit authorization requests for inpatient admissions (PDF)
Kebilidi to require prior authorization for most members (PDF)
Aucatzyl IV to require prior authorization for most members starting Nov. 21 (PDF)
e-referral system out of service for maintenance overnight November 16-17 (PDF)
October 2024
Nov. 5 holiday closure: How to submit authorization requests for inpatient admissions (PDF)
Hympavzi and Imuldosa to have a prior authorization requirement for most members (PDF)
BAHA (Bone-anchored hearing aid) questionnaire removed from the e-referral system (PDF)
We changed how we manage immunoglobulin therapies for most commercial members starting Oct. 1 (PDF)
Prior authorization approvals now valid for 180 days for PTs and OTs in Category A (PDF)
e-referral system out of service for maintenance overnight October 19-20 (PDF)
You can now add comments when answering InterQual Connect questions in the e-referral system (PDF)
Tremfya IV will require prior authorization for Medicare Advantage members starting Dec. 2 (PDF)
Otulfi to have a prior authorization requirement for most members (PDF)
Register now for Oct. 10 webinar on prior authorization programs with Carelon (PDF)
September 2024
Tezspire to have a site-of-care requirement for most commercial members starting Jan. 1 (PDF)
Changes to the Breast Elastography Trigger questionnaire in the e-referral system (PDF)
2025 coverage change for GLP-1 drugs to treat obesity (PDF)
Preferred product for Hemgenix for most commercial members starting Nov. 11 (PDF)
Ocrevus Zunovo SC to have requirements for most commercial members starting Oct. 3 (PDF)
e-referral system out of service for maintenance overnight September 21-22 (PDF)
Rituximab preferred agents to change for Medicare Advantage members starting Jan. 1 (PDF)
August 2024
Pavblu to require prior authorization for most commercial members starting Sept. 5 (PDF)
Sept. 2 holiday closure: How to submit authorization requests for inpatient admissions (PDF)
Niktimvo IV to require prior authorization for most commercial members starting Sept. 5 (PDF)
Enzeevu to require prior authorization for most commercial members starting Aug. 29 (PDF)
e-referral system out of service for maintenance overnight August 17-18 (PDF)
Physician appointment access survey in process (PDF)
Tecelra to require prior authorization for most commercial members starting Aug. 15 (PDF)
July 2024
Preferred immune globulin products for Medicare Advantage members to change starting Nov. 1 (PDF)
Rytelo to require prior authorization for most commercial members starting Aug. 8 (PDF)
Update: Changes coming for select weight loss drugs for some commercial members (PDF)
Blue Cross Behavioral Health no longer requires autism diagnostic re-evaluations (PDF)
Guidelines for billing Avastin for Blue Cross and BCN commercial members (PDF)
Epysqli to require prior authorization for most commercial members starting Aug. 8 (PDF)
Changes to the BCN referral and authorization requirements for Michigan providers document (PDF)
Rytelo will require prior authorization for Medicare Advantage members starting Aug. 1 (PDF)
Updated TurningPoint medical policies for musculoskeletal and pain management procedures (PDF)
Kisunla to require prior authorization for most commercial members starting July 18 (PDF)
e-referral system unavailable on two weekends in July (PDF)
June 2024
Yimmugo and Piasky to require prior authorization for most commercial members starting July 11 (PDF)
July 4-5 holiday closure: How to submit authorization requests for inpatient admissions (PDF)
Utilization management phone closed on June 28 until 1 p.m. (PDF)
Questionnaire changes in the e-referral system starting June 23 (PDF)
Lamzede and Vyjuvek to have requirements for URMBT members with Blue Cross non-Medicare plans (PDF)
June 19 holiday closure: How to submit authorization requests for inpatient admissions (PDF)
e-referral system out of service for maintenance overnight June 15-16 (PDF)
Beqvez will have additional requirements for most commercial members (PDF)
Vyjuvek will have additional requirements for most commercial members starting July 22 (PDF)
Bkemv to require prior authorization for most commercial members starting June 13 (PDF)
Alyglo has requirements for Federal Employee Program non-Medicare members as of June 1 (PDF)
Update: Changes coming for select weight loss drugs for some commercial members (PDF)
Soliris and Ultomiris to have a step therapy requirement for commercial members (PDF)
May 2024
Opuviz and Yesafili to require prior authorization for most commercial members starting June 6 (PDF)
Hemlibra to have a quantity limit requirement for most commercial members (PDF)
Changes to the Hyperbaric oxygen therapy questionnaires in the e-referral system (PDF)
Step therapy requirement added for Saphnelo for Medicare Advantage members starting Sept. 1 (PDF)
May 27 holiday closure: How to submit authorization requests for inpatient admissions (PDF)
New information about Winrevair SC for commercial members (PDF)
We’ll use 2024 InterQual criteria starting Aug. 1 (PDF)
Loqtorzi to have requirements for most members starting Aug. 15 (PDF)
Beqvez will require prior authorization for Medicare Advantage members starting June 1 (PDF)
e-referral system unavailable on two weekends in May (PDF)
Update: Beqvez to require prior authorization for most commercial members starting May 9 (PDF)
April 2024
Pemfexy and Pemrydi RTU to have additional step therapy requirements for most members (PDF)
Hercessi to require prior authorization for most commercial members starting May 16 (PDF)
Guidelines for using the Autism diagnostic evaluation results form (PDF)
Omvoh SC and IV to have a step therapy requirement for most commercial members starting June 3 (PDF)
Update: Spevigo SC to have requirements for most commercial members starting April 25 (PDF)
e-referral system out of service for maintenance overnight April 20-21 (PDF)
Amtagvi will have additional requirements for most commercial members, starting May 28 (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)
Update: 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)
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)
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)
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)
We’re changing how we manage Entyvio SC and Omvoh SC, starting March 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)
Update: Amtagvi to require prior authorization for most commercial members starting Feb. 29 (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)
January 2024
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)
Updated: Entyvio, Omvoh and Wezlana to require prior authorization for most commercial members (PDF)
Questionnaire changes in e-referral starting Jan. 28 (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)
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)
January 2, 2024: Changes to ereferrals.bcbsm.com (PDF)
Jan. 15 holiday closure: How to submit authorization requests for inpatient admissions (PDF)