Behavioral Health

When a patient needs behavioral health care, Blue Cross Blue Shield of Michigan may need to approve it first. Keep in mind that authorization is just a clinical review approval, not a guarantee of payment. You'll still need to verify the necessary coverage for this medical benefit.

For both Blue Cross PPO and Medicare Plus BlueSM PPO members

The documents linked here apply to both Blue Cross PPO and Medicare Plus Blue PPO members.

For behavioral health medical record documentation requirements for outpatient services:

See below for additional resources that apply either to Blue Cross PPO or to Medicare Plus Blue PPO members.

For Blue Cross PPO (commercial) members

Most, but not all, Blue Cross PPO members have their behavioral health coverage managed by New Directions.

To determine whether a group or member's benefits are managed by New Directions or by another organization, contact a behavioral health care manager using the toll-free number on the back of the member's ID card. You can also refer to the Blue Pages Directory chapter of the Blue Cross PPO provider manual for complete contact information.

Here's where to find additional information:

  • For authorizations by New Directions, you can use the New Directions WebPass tool* to request initial and concurrent reviews for inpatient, residential, partial hospital, applied behavior analysis and transcranial magnetic stimulation services and to check the status of these requests. You can also call 1-800-762-2382.
  • For additional information about behavioral health services, refer to the Blue Cross PPO provider manuals. To access this and other resources, log in to Provider Secured Services and click web-DENIS.

Other resources:

For Medicare Plus Blue PPO members

Effective Oct. 16, 2017, the following behavioral health services for Medicare Plus Blue PPO members require authorization through the e-referral system:

  • Initial admission of inpatient, partial hospital and intensive outpatient treatment for members who have been admitted to inpatient care or to a treatment program
  • Extensions of inpatient, partial hospital, intensive outpatient treatment

Outpatient behavioral health services for Medicare Plus Blue PPO members do not require authorization.

Here are some resources to assist you in managing behavioral health services:

You can call Medicare Plus Blue PPO Behavioral Health at 1-888-803-4960 for general assistance with behavioral health services, including:

  • Arranging services or requesting authorization for services
  • Obtaining criteria used to make an authorization decision

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