• Summary of utilization management programs for Michigan providers (PDF)
• Procedure codes for which providers must request prior authorization (PDF)
• Provider preauthorization and precertification requirements (PDF)
• Holiday closures: How to submit authorization requests for inpatient admissions (PDF)
• Diabetes: For coaching, management, behavioral counseling and supplies (PDF) - Includes information about care management and utilization management programs
• Durable medical equipment and prosthetics and orthotics: For authorization determinations (PDF)
• Inpatient medical admissions
• Submitting acute inpatient authorization requests: Frequently asked questions for providers (PDF)
• Inpatient authorization requests: Tips for using the e-referral system – Blue Cross PPO (PDF)
• Inpatient medical admissions, acute care (hospitals): For authorization determinations (PDF) - Includes information about our utilization management program
• Post-acute care: For skilled nursing, rehabilitation and long-term acute care facilities (PDF) - Includes information about our utilization management programs
• Surgeries: For decision support and authorization determinations (PDF) - Includes information about our care management and utilization management programs

• Effective Aug. 1, 2023, there are no local rules for acute inpatient medical admissions of adults.
• 2022 Blue Cross and BCN Local Rules for acute inpatient medical admissions of adults (PDF) – effective March 1, 2022, through July 31, 2023
• Local Rules for acute inpatient medical admissions of adults: Frequently asked questions (PDF) - effective March 1, 2022, through July 31, 2023

• Criteria Request Form (for non-behavioral health cases) (PDF)

• Post-acute care admissions: Submitting authorization requests (PDF)
• Northwood DME/POS management program:
  • Frequently Asked Questions (PDF)
  • Procedure Codes Requiring Prior Authorization (PDF)
• Private duty nursing program (PDF)
• Transplants: For authorization determinations (PDF) - Includes information about utilization management programs

• 2023 Blue Cross and BCN Local Rules for post-acute care (PDF) - for commercial members only, effective Aug. 1, 2023
• 2022 Blue Cross and BCN Local Rules for post-acute care (PDF) - for commercial members only, effective Aug. 1, 2022, through July 31, 2023

• Acute inpatient hospital assessment form (PDF) — for commercial members only
• SNF/acute IPR assessment form (PDF) — for commercial members only
• Federal Employee Program^® Consent for Case Management (PDF)
• LTACH assessment form (PDF) — for commercial members only
• Peer-to-peer reviews:
  • 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)

• Non-emergency air ambulance prior authorization program: Overview for MI and non-MI providers (PDF)
• Air ambulance flight information (non-emergency) form (PDF)
• Air ambulance: For non-emergency flights (PDF) - Includes information about the utilization management program

To access the manual, complete these steps:

1. Log in to our provider portal (availity.com)*.
2. Click Payer Spaces on the Availity menu bar.
3. Click the BCBSM and BCN logo.
4. Click Provider Manuals on the Resources tab.
5. Click Blue Cross commercial.

• Services That Require Authorization – Medicare Plus Blue PPO (PDF)
• About Blue Dot changes to the list of Services That Require Authorization (PDF)
• How to request a peer-to-peer review with a Blue Cross or BCN medical director (PDF)
• Cosmetic procedures: For authorization determinations (PDF) - Includes information about our utilization management programs
• Elective procedures and services: For authorization determinations (PDF) - Includes information about our care management and utilization management programs
• Post-acute care services: Frequently asked questions by providers (PDF)

• Medicare Plus Blue Acute Inpatient Fax Assessment Form (PDF)

• To view authorization criteria, click the “Authorization criteria” link to the right of the service below. If there isn’t a link to an authorization criteria document, we’ll use the pertinent medical policy to make the determination.
• To view a medical policy, open our Medical Policy Router Search page on bcbsm.com. Enter a procedure code in the Policy/Topic Keyword field to search for the pertinent policy.