On Oct. 22, we’ll be launching the new Provider Prior Authorizations website, replacing ereferrals.bcbsm.com. Our goal is to make it easier for you to find the information you need to work with referrals, prior authorizations, and plan notifications for Blue Cross Blue Shield of Michigan and Blue Care Network.

Learn more in the Oct. 6 provider alert.

Archives 2020




December 2020

Reminder: Medicare Advantage SNF claims will be denied when PDPM levels don't match the levels naviHealth authorized

Some drugs not payable when administered by a health care professional to Blue Cross and BCN commercial members, starting April 1

Reminder: BCN covers Cologuard tests only for members age 50 or older

Change: CareCentrix will manage prior authorizations for home health care for Medicare Advantage members for episodes of care starting on or after June 1, 2021

Updated questionnaires available in the e-referral system on Dec. 20

December and January holiday closures: How to submit inpatient authorization requests

e-referral system out of service for maintenance overnight Dec. 19-20

AIM ProviderPortal out of service for maintenance on Dec. 19

Corrected SNF claims for Medicare Plus BlueSM members: Some claims denied due to untimely filing will automatically process for payment after Feb. 2, 2021

We’re expanding access to diabetes monitoring products for commercial members, starting Jan. 1, 2021

Update: Starting March 1, changes coming to site-of-care-requirements for Blue Cross commercial and BCN commercial pediatric members

Reminder: TurningPoint musculoskeletal authorization program expanding in January

Waste avoidance program expansion starting March 1, 2021, for commercial members

Update: Oncology management program for Blue Cross commercial members will not include use of S codes (S0353 and S0354)

November 2020

Peer-to-peer review request process to change Jan. 4 for inpatient medical hospital admissions

Clinical review requirements suspended until further notice for certain hospitals at higher inpatient bed occupancy

Update: New and updated questionnaires available in the e-referral system on Nov. 22

Medical specialty drug prior authorization list will change in January for Blue Cross commercial fully insured groups

Nov. 26-27 holiday closure: How to submit inpatient authorization requests

e-referral system out of service for maintenance overnight Nov. 21-22

October 2020

Accessing the TurningPoint Provider Portal, registering for training and other important information

Nov. 3 holiday closure: How to submit inpatient authorization requests

Prior authorization requests for outpatient CAR-T therapy drugs for Medicare Advantage members

Update: Questionnaire updates in the e-referral system on Oct. 25

e-referral system out of service for maintenance overnight Oct. 17-18

Skyrizi® and Tegsedi® will be covered under the pharmacy benefit for Blue Cross' PPO and BCN HMOSM members, effective Oct. 8, 2020

Medicare Part B medical specialty drug prior authorization list is changing in January 2021

September 2020

Questionnaire updates in the e-referral system in September and October 2020

Medical specialty drug prior authorization lists will change in November for certain members

SNFs must register for and learn the e-referral system before submitting commercial SNF authorization requests through e-referral starting Dec. 1

e-referral system out of service for maintenance overnight September 19-20

Avoid SNF claim denials for Medicare Advantage by matching PDPM levels on claims to the PDPM levels naviHealth authorized

Cardiac implantable device services will require authorization by AIM Specialty Health® for many members

Update: Starting Sept. 1, BCN requires authorization for elective pediatric feeding programs (S0317)

Starting Dec. 1, some drugs covered under the medical benefit will require authorization for Blue Cross and Blue Shield Federal Employee Program® non-Medicare members

Professional providers and facilities can now register for training on TurningPoint's clinical model and more

Viltepso™ will require authorization for commercial members effective September and October 2020

August 2020

Sept. 7 holiday closure: How to submit inpatient authorization requests

IVIG dosing strategy is changing for the Medicare Part B medical specialty drug program, starting Dec. 7

New e-referral system upgrades

Tecartus™ will require authorization for commercial members effective August and September 2020

e-referral system out of service for maintenance overnight August 15-16

Effective Nov. 1, Blue Cross and BCN will have preferred hereditary angioedema medications for our commercial members

During the COVID-19 emergency, we're extending global referrals through at least Dec. 31 for BCN HMOSM members

July 2020

Clinical documentation requirements for authorization requests related to musculoskeletal procedures managed by TurningPoint

Medical specialty drug prior authorization lists are changing in September for BCN HMOSM, Medicare Plus BlueSM PPO and BCN AdvantageSM members

Uplizna™ will have authorization and site-of-care requirements for commercial members effective August and October 2020

e-referral system out of service for maintenance overnight July 18-19

Medicare Plus BlueSM PPO expands prior authorization program to genetic, molecular testing

Effective Oct. 1, Nivestym® and Zarxio® are the preferred filgrastim products for all Blue Cross and BCN commercial and Medicare Advantage members

June 2020

Medicare Part B medical specialty drug prior authorization list is changing Aug. 21 and Sept. 28

July 3 holiday closure: How to submit inpatient authorization requests

Avoid blocked inpatient authorization e-referral submissions by using the correct criteria

We're adding site-of-care requirements for Avsola™, Reblozyl® and Tepezza™ for Blue Cross' PPO members, starting July 1

Updated e-referral questionnaire to open June 28 for BCN and Medicare Plus BlueSM PPO

Reminder: We're experiencing issues with processing some Supartz FX™ (sodium hyaluronate) claims for BCN AdvantageSM members

Medicare Part B medical specialty drug prior authorization list is changing in July and August

e-referral system out of service for maintenance overnight June 20-21

eviCore has updated corePath for physical and occupational therapy authorizations

eviCore simplifies authorization process for radiation oncology, starting July 1, 2020

New e-referral questionnaires to open June 14 for BCN HMOSM

Determinations on requests for inpatient acute care admissions are based on InterQual® criteria, not on the two-midnight rule

May 2020

Updated: More COVID-19-related utilization management changes

VyeptiTM will have authorization and site-of-care requirements for commercial members effective May and July 2020

Medical benefit specialty drug prior authorization lists are changing in July and August for Medicare Plus BlueSM PPO, BCN HMOSM and BCN AdvantageSM members

How to submit non-behavioral health inpatient authorization requests to Blue Cross and BCN during the May 25 holiday closure

Register for training on TurningPoint's clinical model and more

e-referral system out of service for maintenance overnight May 16-17

April 2020

Some Blue Care Network transitional care fax numbers discontinued starting June 1

Recommendations for submitting authorization requests for medical oncology drugs to AIM

Updated: Palforzia™ and Tepezza™ will have authorization and site-of-care requirements for commercial members effective March and May 2020

Updated: We're adding site-of-care requirements for Lemtrada and Tysabri for commercial members, starting May 1

Hospitals must notify naviHealth before transferring Medicare Advantage members to SNFs

We're experiencing issues with processing some Supartz FX™ (sodium hyaluronate) claims for BCN AdvantageSM members

Updated: Changes to authorization durations for elective and non-urgent procedures, including PT, OT and ST, during the COVID-19 pandemic

CHANGE: TurningPoint will manage musculoskeletal procedure authorizations with dates of service on or after July 1, 2020, for certain members

e-referral system out of service for maintenance overnight April 18-19

What to do about e-referral error message

Sarclisa® will require prior authorization starting May 15 for BCN HMOSM, Medicare Plus BlueSM PPO and BCN AdvantageSM members

How to submit inpatient authorization requests to Blue Cross and BCN during the April 10 holiday closure and the e referral weekend software upgrade

How to submit a plan notification for acute care hospital facility admissions and request for post-acute care admissions

Clinical review requirements suspended through May 31 for all admissions to acute care hospitals and for transfers to skilled nursing facilities

March 2020

We'll pay only inpatient facility claims for ZulressoTM starting July 1, for Blue Cross' PPO members

Use e-referral system while Blue Cross and BCN offices are closed on Tuesday, March 24

We’re adding site-of-care requirements for Adakveo® and Givlaari® for Blue Cross' PPO members starting April 1

e-referral system out of service for maintenance overnight March 21-22

Use e-referral system while Blue Cross and BCN offices are closed on March 20 and 23

Authorization requirements eased for COVID-19-related services

In April, we're making changes to coverage for infliximab biosimilar products for Medicare Advantage members

naviHealth is taking measures to keep Medicare Advantage members safe in response to COVID-19

Medicare Part B medical specialty drug prior authorization list is changing in June

No software upgrade on March 8-9 for e-referral system

February 2020

Professional providers and facilities can now register for training on TurningPoint's clinical model and more

Medicare Part B medical specialty drug prior authorization list is changing in April

e-referral system may be slow or problematic after data center move

Interventional pain management services for *64451 and *64625 require authorization starting May 1 for all Blue Cross and BCN members

e-referral system out of service for maintenance three times in February 2020

January 2020

Submit requests for swallow services to BCN, not to eviCore healthcare

Updated e-referral system questionnaires will be released for BCN and Medicare Plus BlueSM PPO on Feb. 2, 2020

Reblozyl® will have authorization and site-of-care requirements for commercial members effective February and April 2020

Authorization requirements are changing for home health, TPN and IDPN services for BCN members

We're removing zoledronic acid drugs from the Medicare Part B medical specialty drug prior authorization list in March

Attend a training session on changes to the Practitioner Performance Summary and utilization management categories for physical therapy providers

Musculoskeletal surgical procedures will require authorization by TurningPoint for Medicare Plus BlueSM PPO and BCN members

Radiation therapy services for A9590 require authorization starting April 1 for all Blue Cross and BCN members

Avsola™ and Givlaari™ will have authorization and site of care requirements for commercial members effective February and March 2020

How to submit inpatient authorization requests to Blue Cross during upcoming holiday closure

How to submit inpatient authorization requests to BCN during upcoming holiday closure

e-referral system out of service for maintenance Jan. 18-19