
Some drugs require prior authorization before they can be delivered or administered in a health care provider's office, clinic, outpatient or home setting. This page offers resources for providers who request prior authorization for physician-administered (infusible/injectable) drugs billed under the medical benefit for BCN commercial and BCN AdvantageSM members.
The process of requesting prior authorization for medical benefit drugs differs according to the member's coverage and the type of drug:
- For BCN commercial members:
- For most medical benefit drugs, submit prior authorization requests through the NovoLogix® web tool. This includes requests for CAR-T cell therapy drugs.
- For medical oncology and supportive care drugs, submit prior authorization requests to Carelon Medical Benefits Management (formerly AIM Specialty Health®).
- For BCN Advantage members:
- For most medical benefit drugs, submit prior authorization requests through NovoLogix. This includes requests for CAR-T cell therapy drugs.
- For medical oncology and supportive care drugs, submit prior authorization requests to Carelon.
Did you know? Michigan’s prior authorization law* requires health care providers to submit prior authorization requests electronically for commercial members. Alternate submission methods are allowed in the case of temporary technological problems, such as power or internet outages; see the information about submitting prior authorization requests through alternate methods below. When you submit your medical drug authorization requests electronically, there are many benefits:
Below, you'll find information on how to submit a medical drug prior authorization request electronically for BCN commercial and BCN Advantage members. You'll also find other helpful resources. |
IMPORTANT! Always verify eligibility and benefits for each member at each visit. A prior authorization approval is not a guarantee of payment.
BCN commercial For BCN commercial members, select from below: How to submit requests electronically using NovoLogix
How to submit requests electronically to Carelon (formerly AIM)
For additional information, refer to: Other resources Newsletter articles (PDF) Lemtrada and Tysabri site-of-care program: FAQ (PDF) In-network home infusion therapy providers and ambulatory infusion centers (PDF) Audaire Health™: |
BCN Advantage Select specialty medications covered under the Medicare Part B medical benefit require prior authorization for members covered under Blue Cross Medicare Advantage plans, including BCN Advantage. For BCN Advantage members, select from below: How to submit requests electronically using NovoLogix
How to submit requests electronically to Carelon (formerly AIM) Starting Jan. 1, 2020:
For additional information, refer to: Other resources BCN Advantage HMO-POS and BCN Advantage medical drug policies and forms webpage Authorization of Part B specialty medications: Frequently asked questions for providers |
RC Claim Assist tool
RC Claim Assist is a web-based resource available to Blue Cross Blue Shield of Michigan and Blue Care Network contracted providers who bill for drugs covered under the medical benefit. RC Claim Assist provides an inclusive overview of medical drug products and a calculation tool to identify the correct National Drug Code and CPT codes to bill, along with the correct NDC quantity, unit of measure and HCPCS billable units according to the package information.
To access RC Claim Assist
- Log in to our provider portal (availity.com*).
- Click Payer Spaces on the menu bar and then click the BCBSM and BCN logo.
- In the Applications tab, click the “RC Claim Assist medical drug coding tool” tile and follow the prompts.
IMPORTANT! The RC Claim Assist drug pricing information is not based on the Blue Cross or BCN administration fee schedule.
- Using the RC Claim Assist tool: Frequently asked questions for providers (PDF)
- Billing instructions: Reporting the National Drug Code (PDF)
For all claims and billing questions, contact PARS / Provider Inquiry at these numbers:
- Physicians and professionals: 1-800-344-8525
- Hospitals or facilities: 1-800-249-5103
Training resources
To help you learn to use the NovoLogix web tool:
- NovoLogix training video on requesting authorizations:
- Click to open the video*.
- Click the arrow located in the center of the "Provider Authorization Video Tutorial" box, to start the video.
- NovoLogix user guide for BCN providers (PDF)
- Billing instructions: Reporting the NDC (PDF)
- Web-based training about NDC billing - Go to our dedicated provider training site*, search on “NDC” and click “National Drug Code billing for medical drug benefits” to start the course.
Note: To register for the provider training site, click here*. We recommend using the same email you use to communicate with Blue Cross for provider-related needs. This will become your user ID.
Additional resources
- Inquiries about drugs covered under the medical benefit: Frequently asked questions for providers (PDF)
- Drugs: For medication adherence, medical benefit drugs and pharmacy benefit drugs (PDF) - Includes information about our care management and utilization management programs
- Oncology: For CAR-T cell therapy, medical oncology and radiation oncology (PDF) - Includes information about our utilization management programs
Alternate methods for submitting prior authorization requests to NovoLogix
If you’re experiencing temporary technological problems that prevent you from accessing NovoLogix, such as a power or internet outage, use one of the following methods to submit prior authorization requests.
- For BCN commercial members, fax to 1-877-325-5979.
- For BCN Advantage members, fax to 1-866-392-6465.
- Call the Blue Cross and BCN Pharmacy Clinical Help Desk at 1-800-437-3803.
- For BCN commercial members only, mail the request to:
Blue Cross Blue Shield of Michigan, Pharmacy Services
Mail Code 512B
600 E. Lafayette Blvd.
Detroit, MI 48226-2998
Alternate methods for submitting prior authorization requests to Carelon
If you’re experiencing temporary technological problems that prevent you from accessing the Carelon provider portal, such as a power or internet outage, submit prior authorization requests to Carelon by:
- For BCN commercial and BCN Advantage members, call 1-844-377-1278.
- For Blue Cross commercial and Medicare Plus Blue members, call 1-800-728-8008.
If Carelon is unable to accept requests by phone due to technical problems, submit the request to Blue Cross or BCN using one of the following methods:
- For BCN commercial members, fax to 1-877-325-5979.
- For Medicare Plus Blue members, fax to 1-866-392-6465.
- Call the Blue Cross and BCN Pharmacy Clinical Help Desk at 1-800-437-3803.
- For BCN commercial members only, mail the request to:
Blue Cross Blue Shield of Michigan, Pharmacy Services
Mail Code 512B
600 E. Lafayette Blvd.
Detroit, MI 48226-2998
Need additional assistance?
For additional help, call the Pharmacy Clinical Help Desk at 1-800-437-3803.
*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.