Provider appeal time frame extended for Blue Cross' PPO

You now have up to 45 days to submit appeals of denied authorization requests related to admissions of Blue Cross' PPO (commercial) members.

This applies to admissions for:

• All members with a Blue Cross' PPO contract
• Care in acute inpatient settings, skilled nursing facilities, long-term acute care hospitals and inpatient rehabilitation settings

You must submit the appeal within 45 days of the date that the initial request was denied.

Changing the appeal submission deadline from 30 to 45 days brings the Blue Cross' PPO appeal deadline requirements into alignment with requirements for other Blue Cross and Blue Care Network products. The Blue Cross' PPO provider manuals will be updated to reflect this change.

We've extended the Blue Cross' PPO time frame to 45 days to accommodate the increased number of requests for peer-to-peer reviews and the time it's taking to schedule those reviews. As a reminder, peer-to-peer review requests must be submitted within 14 days of the denial and prior to an appeal.

For additional information on submitting a request for a peer-to-peer review, refer to the document How to request a peer-to-peer review with a Blue Cross or BCN medical director, which we recently updated.

Posted: November 2019
Line of business: Blue Cross Blue Shield of Michigan