Blue Care Network requires prior authorization for cardiology services as follows.
|Select cardiology services
|BCN Utilization Management — Submit through the e-referral system
|Various cardiology services, including echocardiology
|Carelon Medical Benefits Management
For information about cardiology services for Blue Cross Blue Shield of Michigan commercial and Medicare Plus BlueSM members, see the Blue Cross Cardiology Services page.
How to submit prior authorization requests
To learn how to submit requests, see our Getting Started page.
Submit requests before providing services.
Resources for services managed by BCN Utilization Management
- BCN referral and authorization requirements for Michigan providers (PDF)
- Utilization Management (PDF) chapter of the BCN Provider Manual
- BCN Advantage (PDF) chapter of the BCN Provider Manual
- Blue Cross and BCN medical policies — Open our Medical Policy Router Search page on bcbsm.com. Enter a procedure code in the Policy/Topic Keyword field.
Resources for services managed by Carelon
- Procedures that require prior authorization by Carelon: Cardiology, radiation oncology, radiology (high technology) and sleep studies (in lab) (PDF)
- Frequently asked questions about Carelon: for cardiology, radiology (high technology) and sleep studies (in lab) (PDF) - Answers to questions about prior authorization requirements for cardiology and radiology (high technology) services and in-lab sleep studies.
- Carelon's Clinical guidelines and pathways*
- Cardiology: For home monitoring and cardiology and echocardiology procedures (PDF) —Includes information about care management and utilization management programs
*Clicking this link means that you're leaving the Blue Cross Blue Shield of Michigan and Blue Care Network website. While we recommend this site, we're not responsible for its content.
Carelon Medical Benefits Management is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to manage prior authorizations for select services.