Blue Cross Behavioral Health^SM manages prior authorizations for behavioral health services (for mental health and substance use disorders) for the following members:

• Blue Care Network commercial
• BCN Advantage^SM

Notes:

• For information about behavioral health for Blue Cross Blue Shield of Michigan commercial and Medicare Plus Blue^SM members, see the Blue Cross Behavioral Health page.
• For information about autism services, see the BCN Autism Services page

How to submit prior authorization requests

To learn how to submit requests, see our Getting Started page. Submit requests before providing services.

To find out more about the 2024 changes, view the Blue Cross Behavioral Health Updates 2024 Webinar (video).

Blue Cross Behavioral Health Provider Portal Error Issue – Authorization not found (video).

Out-of-network providers can use the online forms below to submit requests. For best results, use the Google Chrome^™ browser to open and complete these forms.

• TMS Authorization Request Form*
• Psychological and Neuropsychological Testing Request Form*
• Prior Authorization Form* – for other behavioral health services

Utilization management criteria

• To view utilization management criteria, go to the Services That Need Prior Authorization page on bcbsm.com.
• To view Blue Cross and BCN’s medical policies, go to the Medical Policy Router Search webpage on bcbsm.com.

Provider resources

• Summary of utilization management programs for Michigan providers (PDF) — See this document to determine which services require prior authorization
• Procedure codes for which providers must request prior authorization (PDF) — See this document to determine which procedure codes require prior authorization
• Blue Cross Behavioral Health: Frequently asked questions for providers (PDF)
• Documentation requirements and privacy regulations for services other than ABA (PDF)
• Behavioral Health chapter of the BCN Provider Manual (PDF)
• Holiday closures: How to submit authorization requests for inpatient admissions (PDF)
• Quartet Care Navigation Platform (PDF) — FAQ for behavioral health providers
• Quartet flyer (PDF)
• Requirements for providing behavioral health services to BCN members (PDF)
• LLPs and LMFTs — Frequently asked questions (PDF)
• Depression tip sheet (PDF) — For primary care providers
• HEDIS tip sheet for antidepressant medical management (PDF)
• Behavioral health: For mental health and substance use disorders (PDF) — Includes information about care management and utilization management programs
• Behavioral health fee schedule on Provider Resources (PDF) — Access this document on our Provider Resources site, which is accessible through Availity^® Essentials. It’s available by clicking the Member Care menu and clicking Behavioral Health.
• Instructions for filling out CMS-1500 form (02/12) (PDF)

Telehealth resources for providers

• Telemedicine medical policy — To view this document, go to the Medical Policy Router Search webpage on bcbsm.com, enter the name of the medical policy in the Policy/Topic Keyword field and press Enter.
• Telehealth for behavioral health providers (PDF)

Patient care resources

• Behavioral health resources to discuss with your patients (PDF)
• Behavioral health screening tools
• Obtaining, initiating and continuing long-acting medications for behavioral health (PDF)
• Spravato^™ (esketamine) — Information about requesting authorization:
• BCN Medical Benefit Drugs webpage
• Spravato^®: Purchasing and billing information (PDF)
• Outpatient detoxification and follow-up care protocols for treating substance use disorders (PDF)
• Depression office flyer (PDF)
• Depression brochure for members (PDF)

Clinical program requirements

• Clinical program requirements for behavioral health adult intensive and child intensive services (PDF)
• Clinical program requirements for behavioral health crisis services (PDF)
• Clinical program requirements for behavioral health residential psychiatric treatment services (PDF)