• Summary of utilization management programs for Michigan providers (PDF)
• Authorization requirements documents
• BCN referral and authorization requirements for Michigan providers (PDF)
• About Blue Dot Changes to the BCN referral and authorization requirements document for Michigan providers (PDF)
• BCN-managed procedure codes that require authorization for Michigan providers (PDF)
• Non-Michigan providers: Referral and authorization requirements for BCN members (PDF)
• Acute inpatient care
• Submitting acute inpatient authorization requests: Frequently asked questions for providers (PDF)
• For BCN commercial members – Acute inpatient hospital assessment form (PDF)
• For BCN Advantage members – Medicare Advantage inpatient assessment form (PDF)
• Guidelines for bundling admissions (PDF)
• Inpatient medical admissions, acute care (hospitals): For authorization determinations (PDF) - Includes information about our utilization management program
• Post-acute care:
• For BCN commercial members – Post-acute care admissions: Submitting authorization requests (PDF)
• For BCN Advantage members – Post-acute care services: Frequently asked questions by providers (PDF)
• Post-acute care: For skilled nursing, rehabilitation and long-term acute care facilities (PDF) - Includes information about our utilization management programs
• Holiday closures: How to submit authorization requests for inpatient admissions (PDF)
• Air ambulance authorization requests for BCN commercial members:
• Air ambulance flight information (non-emergency) form (PDF)
• Air ambulance initiative: Description (PDF)
• Air ambulance: For non-emergency flights (PDF) - Includes information about the utilization management program
• BCN's Local Rules:
• 2022 Blue Cross and BCN Local Rules for acute care (PDF)
• Local Rules for acute care: Frequently asked questions (PDF)
• 2022 Blue Cross and BCN Local Rules for post-acute care (PDF) - for commercial members only
• BCN's Local Rules effective Aug. 2, 2021, through July 31, 2022 (PDF)
• Criteria Request Form (for non-behavioral health cases) (PDF)
• Peer-to-peer reviews:
• How to request a peer-to-peer review with a Blue Cross or BCN medical director (PDF)
• Physician peer-to-peer-request form (for non-behavioral health cases) (PDF)
• Cardiology: For home monitoring and cardiology and echocardiology procedures (PDF)- Includes information about care management and utilization management programs
• Chiropractic services: For chiropractic manipulations and physical medicine services by chiropractors (PDF) — Includes information about utilization management programs
• Cosmetic procedures: For authorization determinations (PDF) — Includes information about our utilization management programs
• Diabetes: For coaching, management, behavioral counseling and supplies (PDF) — Includes information about care management and utilization management programs
• Durable medical equipment and prosthetics and orthotics: For authorization determinations (PDF) — Includes information about care management and utilization management programs
• Elective procedures and services: For authorization determinations (PDF) — Includes information about care management and utilization management programs
• Laboratory: For genetic testing and molecular testing (PDF) — Includes information about our utilization management programs
• Surgeries: For decision support and authorization determinations (PDF) — Includes information about our care management and utilization management programs
• Transplants: For authorization determinations (PDF) — Includes information about utilization management programs

Authorization criteria and preview questionnaires

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.