Musculoskeletal surgeries and related procedures: New steps for determining whether prior authorization is required for Blue Cross commercial members
We added details to the Determining whether Blue Cross commercial members require prior authorization for musculoskeletal surgeries and related procedures (PDF) document that walk through the steps required to determine whether Blue Cross commercial is a member's primary coverage.
We did this because:
As a result of this difference and other considerations that are specific to Blue Cross commercial plans, it's important to know how to determine whether the service requires prior authorization.
Determining whether prior authorization is required for musculoskeletal procedures
The full process for determining whether a Blue Cross commercial member requires prior authorization for these procedures is:
See the document linked above for details on each piece of this process.
For additional information about the TurningPoint musculoskeletal surgical quality and safety management program, see the Blue Cross Musculoskeletal services page or the BCN Musculoskeletal services page on this website.
As a reminder, TurningPoint manages authorizations for orthopedic, pain management and spinal procedures for the following:
Posted: July 2021
Line of business: Blue Cross Blue Shield of Michigan