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
Blue Cross Blue Shield of Michigan requires prior authorization for post-acute care stays as follows.
| Service | Members | Managed by | |
|---|---|---|---|
| Post-acute care — skilled nursing facilities, inpatient rehabilitation centers and long-term acute care hospitals | Blue Cross commercial | Blue Cross Utilization Management — Submit through the e-referral system. | |
| Medicare Plus BlueSM | For dates of service before Oct. 1 , 2024: Home & Community Care (formerly known as naviHealth, Inc.) |
For dates of service on or after Oct. 1 , 2024: Blue Cross Utilization Management — Submit through the e-referral system. |
|
For information about post-acute care services for Blue Care Network commercial and BCN AdvantageSM members, see the BCN Post-Acute Care 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 services managed by Blue Cross Utilization Management
- Post-acute care requirements: Information for providers (PDF)
- Local rules — See the Services that need prior authorization page on bcbsm.com
- Assessment forms
- LTACH assessment form (PDF)
- SNF/acute IPR assessment form (PDF)
- How to request a peer-to-peer review with a Blue Cross or BCN medical director (PDF)
- Physician peer-to-peer request form (for non-behavioral health cases) (PDF)
- For Medicare Advantage members only: Post-acute care: NOMNC and DENC forms (PDF)
Additional resources
- Holiday closures: How to submit authorization requests for inpatient admissions (PDF)
- Post-acute care: For skilled nursing, rehabilitation and long-term acute care facilities (PDF) — Includes information about our care management and utilization management programs
Resources for services managed by Home & Community Care
For dates of service on or after Oct. 1, 2024, prior authorization requests are managed by Blue Cross Blue Shield of Michigan or Blue Care Network.
Refer to Post-acute care services: Frequently asked questions by providers (PDF) for information about the Home & Community Care program and to learn how to submit retroactive authorization requests on or after Oct. 1, 2024, for dates of service before Oct. 1, 2024.
*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.
Home & Community Care is an independent company that manages prior authorizations for post-acute care services for Blue Cross Blue Shield of Michigan and Blue Care Network members who have Medicare Advantage plans.