Carelon Medical Benefits Management manages prior authorizations for high-tech radiology services for:

• Blue Cross Blue Shield of Michigan commercial
• Fully insured groups and individual members
• Self-funded groups — Includes UAW Retiree Medical Benefits Trust non-Medicare members
• Medicare Plus Blue^SM members

Notes:

• For Blue Cross commercial, see the Carelon exclusion list for Blue Cross Blue Shield of Michigan Commercial (PDF) to learn about the health plan, groups, and settings and scenarios for which prior authorization isn't required.
• The requirements outlined above don’t apply to the UAW Retiree Health Care Trust (group number 70605) or the UAW International Union (group number 71714).
• For information about high-tech radiology services for Blue Cross Blue Shield of Michigan commercial and Medicare Plus Blue^SM members, see the BCN Radiology Services, High Tech 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 most members: Procedures that require prior authorization by Carelon: Cardiology, radiation oncology, radiology (high technology) and sleep studies (in lab) (PDF)
• For FEP members: Procedures that require authorization by Carelon: Radiology (high technology) (PDF) - A list of the procedure codes Carelon manages for FEP members for services received in Michigan
• Frequently asked questions about Carelon: for cardiology, radiology (high technology) and sleep studies (in lab) (PDF) — Answers to questions about prior authorization requirements for cardiology services, high-tech radiology services and in-lab sleep studies
• Carelon's Clinical guidelines and pathways*
• Radiology procedures (high-tech imaging): For prior authorization determinations (PDF) — Includes information about 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.

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.