• Summary of utilization management programs for Michigan providers (PDF)
• 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)
• Holiday closures: How to submit authorization requests for inpatient admissions (PDF)
• Northwood DME/POS management program:
  • Frequently Asked Questions (PDF)
  • Procedure Codes Requiring Prior Authorization (PDF)
  • Determining whether Blue Cross commercial members require prior authorization through Northwood (PDF)
• Durable medical equipment and prosthetics and orthotics: For authorization determinations (PDF)
• Diabetes: For coaching, management, behavioral counseling and supplies (PDF) - Includes information about care management and utilization management programs
• 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
• Transplants: For authorization determinations (PDF) - Includes information about utilization management programs

• 2022 Blue Cross and BCN Local Rules for acute care (PDF)
• Local Rules for acute care: Frequently asked questions (PDF)
• 2022 Blue Cross and BCN Local Rules for post-acute care (PDF) - for commercial members only
• 2021 Blue Cross modifications of InterQual^® criteria, effective Aug. 2, 2021, through July 31, 2022 (PDF)

• Criteria Request Form (for non-behavioral health cases) (PDF)
• Acute Inpatient Fax Assessment Form (PDF)
• SNF/acute IPR assessment form (PDF) — Michigan providers should attach the completed form to the request in the e-referral system. Non-Michigan providers should fax the completed form using the fax numbers on the form.
• Federal Employee Program^® Consent for Case Management (PDF)
• LTACH Assessment Form (PDF) — Michigan and non-Michigan providers should fax the completed form using the fax numbers on the form.
• 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)
• Request for Preauthorization Form (PDF)

• Air ambulance flight information (non-emergency) form (PDF)
• Air ambulance initiative: Description (PDF)
• Air ambulance: For non-emergency flights (PDF) - Includes information about the utilization management program

To access the manual, complete these steps:

1. Visit bcbsm.com/providers
2. Log in to Provider Secured Services.
3. Click Provider Manuals.
4. Click Blue Cross PPO Provider Manual.