Blue Cross Blue Shield of Michigan requires prior authorization for home-based services as follows.
|Home health care
|Medicare Plus BlueSM members
|Private Duty Nursing*
|Some Blue Cross commercial groups
|Blue Cross Utilization Management — Submit through the e-referral system.
For information about home-based services for Blue Care Network commercial and BCN AdvantageSM members, see the BCN Home-Based Services page.
How to submit prior authorization requests
To learn how to submit requests, see our Getting Started page.
Submit requests before providing services.
Resources for home health care services
- Home health care: Frequently asked questions for providers (PDF)
- Medicare Plus Blue home health care claims: Frequently asked questions for providers (PDF)
- Home health care: Quick reference guide (PDF)
- Home health care: Clinical documentation requirements (PDF)
- Home health care: Submitting authorization requests to CareCentrix (PDF)
- Home health care: Linking your agency's NPI(s) and TIN(s) (PDF)
- Skilled nursing facilities and home health agencies
- CareCentrix HomeBridge® Portal Auth Request Guide** (PDF)
Resources for private duty nursing
- Home-based services: For chronic condition monitoring, in-home-medical services, authorization determinations and more (PDF) — Includes information about our care management and utilization management programs
We offer provider training. To learn more, see our Training Tools page.
*Not all groups have private duty nursing as a benefit. Check each member’s eligibility and benefits prior to performing services.
**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.
CareCentrix is an independent company that manages the prior authorization of home health care services for Blue Cross Blue Shield of Michigan and Blue Care Network members who have Medicare Advantage plans.