Authorization Requirements & Criteria

Important information during the coronavirus (COVID-19) pandemic

For temporary changes and recommendations for providers, refer to our COVID-19 provider webpage.

Find more information for providers:

  1. Log in to our provider portal (availity.com)*.
  2. Click Payer Spaces on the Availity menu bar.
  3. Click the BCBSM and BCN logo.
  4. Click Secure Provider Resources (Blue Cross and BCN) on the Resources tab.
  5. Click Coronavirus on the Member Care tab.

Below are links to documents detailing Blue Care Network's authorization and referral requirements for services managed by BCN, including lists of procedures that require authorization and authorization criteria and preview questionnaires for various procedures. These apply to services other than drugs covered under the medical benefit. In addition, there are links to information about the Pediatric Choice and Woman's Choice programs.

For drugs covered under the medical benefit, visit the Medical Benefit Drugs page in the BCN section of this website.

For Blue Cross Complete utilization management information, go to MiBlueCrossComplete.com/providers.

Referral and authorization information

Authorization criteria and preview questionnaires

We use either our authorization criteria or our medical policies to make determinations on prior authorization requests for the services listed below. To view these items:

  • To view authorization criteria, click the “Authorization criteria” link to the right of the service below. If there isn’t a link to an authorization criteria document, we’ll use the pertinent medical policy to make the determination.
  • To view a medical policy, open our Medical Policy Router Search page on bcbsm.com. Enter a procedure code in the Policy/Topic Keyword field to search for the pertinent policy.

Pediatric Choice

Woman's Choice

The Woman's Choice program allows BCN members to directly access affiliated physicians who perform obstetric or gynecologic services. In line with Woman's Choice guidelines, an obstetrician-gynecologist may perform or order some services without a referral from the primary care physician.

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