Access & Training
Blue Cross
Referrals & Authorizations
- Prior Authorization
- Acute Inpatient Admissions
- Air Ambulance
- Autism
- Behavioral Health
- Cardiology
- Diabetes Supplies
- DME / P&O
- Home Health Care
- Medical Benefit Drugs
- Musculoskeletal Services
- Oncology
- Pain Management Services
- Pharmacy Benefit Drugs
- Post-Acute Care
- Private Duty Nursing
- Radiology
- Sleep Studies
- Transplant Services
Blue Cross Products with
Unique Requirements
Additional Resources
Behavioral Health
For information about behavioral health services for dates of service before Jan. 1, 2024, see Behavioral health information for dates of service before Jan. 1, 2024 (PDF).
Blue Cross Behavioral HealthSM manages prior authorizations for behavioral health services (for mental health and substance use disorders) for the following members:
- Blue Cross Blue Shield of Michigan commercial
- Medicare Plus BlueSM
Notes:
- For information about behavioral health for Blue Care Network commercial and BCN AdvantageSM members, see the BCN Behavioral Health page.
- For information about autism services, see the Blue Cross 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).
Blue Cross Behavioral Health Provider Portal Error Issue – Authorization not found (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.
- TMS Authorization Request Form*
- Psychological and Neuropsychological Testing Request Form*
- Prior Authorization Form* – for other behavioral health services
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.
Provider resources for all members
- Summary of utilization management programs for Michigan providers (PDF) — See this document to determine which services require prior authorization
- Procedure codes for which providers must request prior authorization (PDF) — See this document to determine which procedure codes require prior authorization
- Blue Cross Behavioral Health: Frequently asked questions for providers (PDF)
- Documentation requirements and privacy regulations for services other than ABA (PDF)
- Holiday closures: How to submit authorization requests for inpatient admissions (PDF)
- Quartet Care Navigation Platform (PDF) — FAQ for behavioral health providers
- Quartet flyer (PDF)
- Depression tip sheet (PDF) — For primary care providers
- HEDIS tip sheet for antidepressant medical management (PDF)
- Behavioral health: For mental health and substance use disorders (PDF) — Includes information about care management and utilization management programs
Provider resources for Blue Cross commercial members
- Requirements for providing behavioral health services to Blue Cross commercial members (PDF)
- Intensive outpatient program and partial hospitalization program: Coverage, authorization and billing guidelines (PDF)
- LLPs and LMFTs — Frequently asked questions (PDF)
- Blue Cross Commercial Provider Manual — See the Provider Manuals page on bcbsm.com to learn how to access our provider manuals
Provider resources for Medicare Plus Blue Members
Telehealth resources for providers
- 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)
Patient care resources
- Behavioral health resources to discuss with your patients (PDF)
- Behavioral health screening tools
- Obtaining, initiating and continuing long-acting medications for behavioral health (PDF)
- Spravato™ (esketamine) — Information about requesting authorization:
- Outpatient detoxification and follow-up care protocols for treating substance use disorders (PDF)
- Depression office flyer (PDF)
- Depression brochure for members (PDF)