Carelon Medical Benefits Management manages prior authorizations for in-lab sleep studies for the following Blue Cross commercial members:

• All fully insured groups and individual members
• Most sef-funded groups —
• Includes UAW Retiree Medical Benefits Trust non-Medicare members
• For exceptions, see the Carelon exclusion list for Blue Cross Blue Shield of Michigan Commercial (PDF)

Notes:

• 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 sleep studies for Blue Care Network commercial and Medicare Advantage^SM members, see the BCN Sleep Studies 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 prior authorization requirements for cardiology services, high-tech radiology services and in-lab sleep studies
• Sleep studies: 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.