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
Oncology Services
Blue Care Network requires prior authorization for oncology services as follows.
| Service | Members | Managed by |
|---|---|---|
| Medical oncology | See the following webpages on this website: | |
| Radiation oncology, including proton beam therapy |
|
EviCore by Evernorth® |
For information about oncology services for Blue Cross Blue Shield of Michigan commercial and Medicare Plus BlueSM members, see the Blue Cross Oncology 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 radiation oncology services
- Procedures that require prior authorization by eviCore healthcare (PDF) — Lists procedure codes for which eviCore manages prior authorizations
- Services reviewed by eviCore for Blue Cross and BCN (PDF) — Outlines the types of services for which eviCore manages prior authorizations, how to submit requests, where to find clinical criteria and guidelines, and more
- Authorizations Quick Reference Guide (PDF) — Explains how to submit prior authorization requests to eviCore
- Oncology: For CAR-T cell therapy, medical oncology and radiation oncology (PDF) — Includes information about utilization management programs
*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.
EviCore by Evernorth is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to manage prior authorizations for select services.