Blue Cross Blue Shield of Michigan requires prior authorization for certain procedures to ensure that members get the right care at the right time and in the right location.

Health care providers must submit prior authorization requests before providing services. See the e-referral User Guide to learn how.

Authorization information for Blue Cross commercial and Medicare Plus Blue members

• Summary of utilization management programs for Michigan providers (PDF)
• Procedure codes for which providers must request prior authorization (PDF)
• Prior authorization requirements for Michigan and non-Michigan providers for Blue Cross commercial and Medicare Plus Blue^SM (PDF)
• How to access the criteria used for a prior authorization determination (for non-behavioral health cases) (PDF)
• 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)

Authorization information for Blue Cross commercial members

• Federal Employee Program^® Consent for Case Management (PDF)
• Prior authorization requirements for MESSA members (PDF)*

Authorization information for Medicare Plus Blue members

• Medicare Plus Blue PPO Provider Manual (PDF)
• Services That Require Authorization – Medicare Plus Blue PPO (PDF)
• Preview questionnaires and medical necessity criteria (PDF) — For select services, links to preview questionnaires that show questions providers must answer in the e-referral system

Utilization management forms

You can find links to forms related to utilization management on our Provider Resources site. To access the forms:

1. Log in to our provider portal (availity.com*).
2. Click Payer Spaces on the menu bar and then click the BCBSM and BCN logo.
3. Click the Resources tab.
4. Click Secure Provider Resources (Blue Cross and BCN).
5. Click the Forms menu and make the appropriate selection.

Documents and forms for noncontracted or non-Michigan providers

• Prior authorization requirements for Michigan and non-Michigan providers for Blue Cross commercial and Medicare Plus Blue^SM (PDF)
• For Providers: What if I Don’t Participate with Medicare? page on bcbsm.com. This page provides access to the Waiver of Liability Statement, along with other pertinent documents and forms

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