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
Home Health Care Services After Oct. 1, 2024
For dates of service on or after Oct. 1, 2024, home health care services don't require prior authorization. However, out-of-network providers must continue to submit prior authorization requests before providing services to BCN Advantage members.
For claims submitted on or after Oct. 1, 2024, our systems won't look for an approved prior authorization regardless of the date of service. In addition, we won't accept retroactive authorization requests.
Blue Cross Blue Shield of Michigan requires prior authorization for home health care as follows.
| Service | Members | Managed by |
|---|---|---|
| Home health care | Medicare Plus BlueSM members | CareCentrix® |
Notes:
- For information about home health care for Blue Care Network commercial and BCN AdvantageSM members, see the BCN Home Health Care page.
- For information about home private duty nursing, see the Blue Cross Private Duty Nursing 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)
Additional resources
- 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
*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.