Blue Cross Behavioral Health^SM 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 Blue^SM

Notes:

• For information about behavioral health for Blue Care Network commercial and BCN Advantage^SM 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.

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)
• Depression tip sheet (PDF) — For primary care providers
• 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)
• 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

• Medicare Plus Blue PPO Provider Manual (PDF)

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 Crisis Care webpage on bcbsm.com
• 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:
• Blue Cross Medical Benefit Drugs webpage
• Spravato^®: Purchasing and billing information (PDF)
• Outpatient detoxification and follow-up care protocols for treating substance use disorders (PDF)
• Depression office flyer (PDF)
• Depression brochure for members (PDF)

Clinical program requirements

• Various behavioral health programs and services (PDF) — Use this document to access links to all requirements documents
• Adult intensive and child intensive services (PDF)
• Urgent care and crisis services (PDF)
• Opioid treatment programs (PDF)
• Partial hospitalization and intensive outpatient programs (PDF)
• Residential psychiatric treatment services (PDF)
• Residential treatment services for substance use disorders (PDF)