Access & Training
BCN
Referrals & Authorizations
- Prior Authorization & Plan Notification
- Acute Inpatient Admissions
- Air Ambulance
- Autism
- Behavioral Health
- Cardiology
- Chiropractic Services
- Diabetes Supplies
- DME / P&O
- Home Health Care
- Laboratory Services
- Medical Benefit Drugs
- Musculoskeletal Services
- Oncology
- Pain Management
- Pharmacy Benefit Drugs
- Post-Acute Care
- Private Duty Nursing
- PT, OT, ST and Physical Medicine
- Radiology
- Sleep Studies
- Transplant Services
BCN Products with
Unique Requirements
Additional Resources
Cardiology Services
Blue Care Network requires prior authorization for cardiology services as follows.
| Service | Members | Managed by |
|---|---|---|
| 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.
Utilization management criteria
- To view utilization management criteria for commercial members, go to the Services That Need Prior Authorization page on bcbsm.com.
- To view utilization management criteria for Medicare Advantage members, go to the Medicare Advantage Prior Authorization page on bcbsm.com.
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
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.
Additional resources
- Cardiology: For home monitoring and cardiology and echocardiology procedures (PDF) —Includes information about care management and utilization management programs
- Procedure codes for which providers must request prior authorization (PDF) — See this document to determine which procedure codes require prior authorization
*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.