Carelon Medical Benefits Management manages prior authorizations for select cardiology services as follows.

For information about cardiology services for Blue Care Network commercial and BCN Advantage^SM members, see the BCN Cardiology Services page.

How to submit prior authorization requests

To learn how to submit requests, see our Getting Started page.

Submit requests before providing services.

Utilization management criteria

• To view utilization management criteria for commercial members, go to the Services That Need Prior Authorization page on bcbsm.com.
• To view utilization management criteria for Medicare Advantage members, go to the Medicare Advantage Prior Authorization page on bcbsm.com.

Resources

• Procedures that require prior authorization by Carelon: Cardiology, radiation oncology, radiology (high technology) and sleep studies (in lab) (PDF)
• Procedure codes for which providers must request prior authorization (PDF) — See this document to determine which procedure codes require prior authorization
• Frequently asked questions about Carelon: for cardiology, radiology (high technology) and sleep studies (in lab) (PDF) — Answers to questions about authorization requirements for cardiology services, high-tech radiology services and in-lab sleep studies
• Cardiology: For home monitoring and hypertension management and for procedures that require prior authorization (PDF) — Includes information about care management and utilization management programs

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Carelon Medical Benefits Management is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to manage prior authorizations for select services.