Access & Training
BCN
Authorizations / Referrals
- Authorization Requirements & Criteria
- Provider Manual Chapters
- Autism
- Bariatric Surgery
- Behavioral Health
- Blue Elect Plus POS
- Carelon-Managed Procedures (formerly AIM)
- eviCore-Managed Procedures
- Forms
- Healthy Blue Choices POS
- Home Health Care
- Medical Benefit Drugs
- MSU Health Plans
- Musculoskeletal Services
- Outpatient PT, OT, ST
- Pharmacy Benefit Drugs
- Sleep Management Program
Additional Resources
Blue Care Network provides materials and resources to assist you with your behavioral health referrals. In addition to the information listed on this page, you can access the complete version of the BCN Provider Manual and other behavioral health resources including the BCN Behavioral Health Fee Schedule on the Behavioral Health page of the Member Care tab on the Provider Resources site. If you are a Michigan provider, you can access the Provider Resources site through the Resources tab of our payer space on our provider portal.
Thank you to those who completed the Behavioral Health Quality Improvement Program Survey. The survey completion period has ended. Please watch for more information about BCN's new behavioral health quality improvement program in BCN Provider News.
Forms for requesting authorization
Utilization management criteria
InterQual®. BCN Behavioral Health uses Change Healthcare's InterQual Behavioral Health Criteria as utilization management guidelines subject to the modifications posted below. To request a copy of the specific InterQual criteria used to make a decision on a member's case, call BCN Behavioral Health at 1-877-293-2788.
Modifications of InterQual criteria starting Aug. 1, 2022. BCN Behavioral Health uses modified InterQual criteria for decisions about the following services:
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Modifications of InterQual criteria starting Aug. 2, 2021, through July 31, 2022. BCN Behavioral Health uses modified InterQual criteria for decisions about the following services:
Local criteria. BCN Behavioral Health uses its own utilization management criteria (local rules) for decisions about the following services:
- For local rules on autism spectrum disorder / applied behavior analysis, see the BCN Autism webpage.
- Neurofeedback for attention deficit disorder / attention deficit hyperactivity disorder (PDF) medical policy
- Telemedicine (PDF) medical policy. (Although the effective date shown on the policy is Nov 1, 2020, the removal of BCN's originating site requirement is effective March 17, 2020.)
- Transcranial magnetic stimulation (PDF) medical policy
Medical record documentation requirements
Other resources
- Behavioral health resources to discuss with your patients (PDF)
- Behavioral health screening tools
- Quartet Care Navigation Platform (PDF) – FAQ for behavioral health providers
- Behavioral Health e-referral User Guide (PDF)
- Submitting authorization requests through e-referral - FAQ (PDF)
- Holiday closures: How to submit authorization requests for inpatient admissions (PDF)
- BCN Provider Manual — Behavioral Health chapter (PDF)
- Instructions for filling out CMS-1500 form (02/12) (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) – For behavioral health providers
- Depression office flyer (PDF)
- Depression brochure for members (PDF)
- Administering long-acting injectable medications at home (behavioral health) (PDF)
- Spravato™ (esketamine) — Information about requesting authorization:
- Outpatient detoxification and follow-up care protocols for treating substance use disorders (PDF)
- Behavioral health: For mental health and substance use disorders (PDF) - Includes information about care management and utilization management programs
Contact information
- Provider Inquiry Contact Information
Call for general assistance with behavioral health services, including:
- Assistance in arranging services
- Request authorization for services
- Discuss or receive information on criteria used to render an authorization decision
- Claims inquiries
The only exceptions are for prior authorization for psychological assessment prior to bariatric surgery and authorization for acute detoxification services. For these situations call 1-800-392-2512. - BCN Behavioral Health Provider Outreach assistance
Go to the Provider contact us section of bcbsm.com to locate contact information for assistance with the following:
- Enrollment and credentialing questions
- Contractual issues
- Recurring problems or unresolved issues
- Education and training assistance on BCN policies, procedures and programs