Appealing Blue Cross Medicare Plus BlueSM PPO acute inpatient hospital authorization decisions

All providers have the right to appeal an adverse decision made by the Blue Cross Medicare Plus Blue PPO utilization management staff on an inpatient admission authorization request.

The instructions for submitting an appeal are within the Blue Cross Medicare Plus Blue PPO Provider Manual (in the Utilization management chapter, and the "Contracted MI Provider Acute Inpatient Admission Appeals" section).

Expedited appeals: You may ask for an expedited appeal when circumstances require that we make a decision in a short period of time. To request an expedited appeal, call 1-866-807-4811.

First-level appeals: Send these to Medicare Plus Blue by fax, email or mail within 45 calendar days of the date noted on the written denial notification. You can submit additional clarifying clinical information to support your request, as follows:

Second-level appeals: Send these to us within 21 calendar days of the date noted on the first-level appeal decision.

Look for upcoming articles on this topic in The Record.

Posted: July 2018
Line of business: Blue Cross Blue Shield of Michigan