Prior Authorization and Plan Notification

Blue Care Network requires prior authorization for certain procedures to ensure that members get the right care at the right time and in the right location.

For BCN commercial members only, we require plan notification for certain services. Plan notification alerts BCN to a scheduled service and facilitates claims payment (clinical review isn’t needed). Providers must follow the requirements that apply to the region in which their medical care group’s headquarters is located:

  • In the East and Southeast regions, providers must submit plan notification to BCN through the e-referral system.
  • In the Mid, West and Upper Peninsula regions, plan notification isn’t required so providers don’t need to submit anything in the e-referral system.

Health care providers must submit both prior authorization requests and plan notifications before providing services. See the e-referral User Guide to learn how.

Authorization Information

Authorization criteria and preview questionnaires for select services

We use our authorization criteria or our medical policies to make determinations on prior authorization requests for select services. To determine which services have authorization criteria and view authorization criteria and preview questionnaires, see the Authorization criteria and preview questionnaires (PDF).

Utilization management forms

You can find links to forms related to utilization management on our Provider Resources site. To access the forms:

  1. Log in to our provider portal (*).
  2. Click Payer Spaces on the menu bar and then click the BCBSM and BCN logo.
  3. Click the Resources tab.
  4. Click Secure Provider Resources (Blue Cross and BCN).
  5. Click the Forms menu and make the appropriate selection.

Documents and forms for noncontracted or non-Michigan providers

Note: For utilization management information for Blue Cross Complete, go to

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