Blue Cross Behavioral Health^SM manages prior authorizations for autism treatment for the following members:

• Blue Cross Blue Shield of Michigan commercial
• Medicare Plus Blue^SM

Notes:

• Autism benefits for Blue Cross commercial members comply with Michigan-mandated benefits. The mandate doesn’t apply to some self-funded employer groups or to Medicare Advantage or Medicare supplement plans, such as Medicare Plus Blue^SM or Blue Cross Complete (Medicaid). Always check member benefits and eligibility.
• For information about autism services for Blue Care Network and BCN Advantage^SM members, see the BCN Autism Services page.

How to submit prior authorization requests

To learn how to submit requests, see our Getting Started page. Submit requests before providing services.

To find out more about the 2024 changes, view the Blue Cross Behavioral Health Updates 2024 Webinar (video).

Out-of-network providers can use the online forms below to submit requests. For best results, use the Google Chrome^™ browser to open and complete these forms.

• Applied Behavioral Analysis Assessment Form*
• Applied Behavior Analysis Treatment Request Form*

Utilization management criteria

• To view utilization management criteria, go to the Services That Need Prior Authorization page on bcbsm.com.
• To view Blue Cross and BCN’s medical policies, go to the Medical Policy Router Search webpage on bcbsm.com.

Autism resources

• Blue Cross Behavioral Health: Frequently asked questions for providers (PDF)
• Autism coverage overview (PDF)
• Obtaining an autism diagnostic evaluation and finding treatment (PDF)
• Documentation requirements for autism services (PDF)
• Autism diagnostic evaluation results form (PDF)
• Requirements for diagnostic evaluations by approved autism evaluation centers and independent evaluation teams (PDF)
• Letter of intent to become an approved autism evaluation center (PDF)
• AAEC evaluation and billing guidelines (PDF)
• Attestation form for psychologists interested in providing ABA (PDF)
• Autism: Billing guidelines and procedure codes (PDF)
• Behavioral health: For mental health and substance use disorders (PDF) — Includes information about care management and utilization management programs

Telehealth resources

• Telemedicine medical policy — To view this document, go to the Medical Policy Router Search webpage on bcbsm.com, enter the name of the medical policy in the Policy/Topic Keyword field and press Enter.
• Telehealth for behavioral health providers (PDF)
• Guidelines for autism interventions delivered via telemedicine (ABA and skills training) (PDF)

More information

More information about the state law on autism is available at www.mi.gov/autism.*

*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.