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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)

ElahereTM, Imjudo®, TecvayliTM, LunsumioTM 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)

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)

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)

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

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 HealthTM 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)

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)

Jemperli and OpdualagTM 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)

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)

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)

CimerliTM and XenpozymeTM 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)

RebyotaTM 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)

BriumviTM and LeqembiTM 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)



December 2022

Assisted reproductive technology benefit expanded, starting Jan. 1. 2023 (PDF)

Generic pemetrexed to require prior authorization for Medicare Advantage members, starting Jan. 1 (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)

Fylnetra® and RolvedonTM to require prior authorization for most commercial members starting March 13 (PDF)

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

AIM won’t require prior authorization for 29 medical oncology drugs for most members starting Jan. 1 (PDF)

Updated fax forms for submitting prior authorization requests to TurningPoint for musculoskeletal procedures (PDF)

Hemgenix® and TzieldTM to require prior authorization for most members starting in December (PDF)

Issue now resolved: eviCore healthcare® call center phone and fax lines are currently unavailable (PDF)

November 2022

XenpozymeTM and Spevigo® to have site-of-care requirements for most commercial members starting March 1 (PDF)

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)

Prior authorization and billing reminders for SNF interrupted stays for Medicare Advantage members (PDF)

Updates related to swallow services for BCN (PDF)

CareCentrix® home health care: Reference materials and recorded training will be available Oct. 27, 2022 (PDF)

Reimbursement for certified opioid treatment programs to change in 2023 (PDF)

XenpozymeTM and Zynteglo® to require prior authorization for Medicare Advantage members, starting Nov. 1 (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)

CareCentrix® home health care: Improved processes for prior authorization requests for Medicare Plus Blue (PDF)

Avsola® to require prior authorization for Blue Cross and Blue Shield Federal Employee Program® non-Medicare members starting Jan. 1 (PDF)

September 2022

AIM ProviderPortal operating slowly (PDF)

Update: We’re changing how we manage biologic asthma therapies, starting Jan. 1 (PDF)

Additional medical benefit drugs will require prior authorization for URMBT members with Blue Cross non-Medicare plans starting Jan. 1 (PDF)

Management of medical benefit drugs moving from Accredo® to Blue Cross for URMBT Blue Cross non-Medicare members (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)

Three additional medications require prior authorization for Medicare Advantage members, starting Aug. 8 (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)

Starting Aug. 1, radiology code *71271 won’t require prior authorization for Blue Cross commercial members (PDF)

Amvuttra™ and Skyrizi® IV to require prior authorization for most commercial members starting July 28 (PDF)

Starting Jan. 1, requests for commercial inpatient rehabilitation admissions and extensions must be submitted through e-referral and not by fax (PDF)

We use clinical information to validate providers’ answers to some questionnaires in the e-referral system (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)

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