Blue Cross Blue Shield of Michigan manages prior authorizations for acute inpatient medical and surgical admissions (non-behavioral health) for:

• Blue Cross commercial members
• Medicare Plus Blue^SM members

For information about acute inpatient admissions for Blue Care Network commercial and BCN Advantage^SM members, see the BCN Acute Inpatient Medical and Surgical Admissions page.

How to submit prior authorization requests

To learn how to submit requests, see our Getting Started page.

Submit requests before providing services.

Resources for Blue Cross and Medicare Plus Blue members

• Submitting acute inpatient authorization requests: Frequently asked questions for providers (PDF)
• Holiday closures: How to submit authorization requests for inpatient admissions (PDF)
• Clinical criteria: For dates of service on or after Aug. 1, 2023, we use InterQual^® criteria to make authorization determinations on acute inpatient medical and surgical admissions for adults. There are no local rules.
  
  Note: For dates of service from March 1, 2022, through July 31, 2023, we used the 2022 Blue Cross and BCN Local Rules for acute inpatient medical admissions of adults care (PDF). For more information, see this frequently asked question (PDF) document.
• How to request a peer-to-peer review with a Blue Cross or BCN medical director (PDF)
• Physician peer-to-peer request form (for non-behavioral health cases) (PDF)
• Acute inpatient admissions: For authorization determinations (PDF) — Includes information about our utilization management program

Resources for Blue Cross commercial members

• Acute inpatient hospital assessment form (PDF)

Resources for Medicare Plus Blue members

• Medicare Advantage inpatient assessment form (PDF)
• See the FFS & MA IM webpage* on the cms.gov website to access the following:
  • Important Message from Medicare
  • Detailed Notice of Discharge
• For patients in observation:
  • Medicare Advantage inpatient assessment form*
  • MOON form instructions (PDF)*

Training for acute care inpatient hospitals in Michigan on requesting peer-to-peer reviews and appeals

We offer provider training. To learn more, see our Training Tools page.

*Clicking this link means that you're leaving the Blue Cross Blue Shield of Michigan and Blue Care Network website. While we recommend this site, we're not responsible for its content.