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-Based Services
- Laboratory Services
- Medical Benefit Drugs
- Musculoskeletal Services
- Oncology
- Pain Management
- Pharmacy Benefit Drugs
- Post-Acute Care
- PT, OT, ST and Physical Medicine
- Radiology
- Sleep Studies
- Transplant Services
BCN Products with
Unique Requirements
Additional Resources
PT, OT, ST and Physical Medicine Services
eviCore® healthcare manages prior authorizations for the following services and members:
| Service | Members |
|---|---|
| Physical, occupational and speech therapy by independent physical therapists, outpatient therapy providers, physician practices and hospital-based outpatient therapy centers Note: For autism-related services on or after Jan. 1, 2024, prior authorization isn’t required for members 19 years of age or older. See the BCN Autism page for additional information. |
|
| Physical medicine services by chiropractors or athletic trainers Note: For autism-related services on or after Jan. 1, 2024, prior authorization isn’t required for members 19 years of age or older. See the BCN Autism page for additional information. |
Blue Care Network commercial |
Note: The requirements above don’t apply to members with BCN 65 plans.
How to submit prior authorization requests
To learn how to submit requests, see our Getting Started page.
Submit requests before providing services.
Resources
- Procedure codes that require 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
- Utilization Management chapter (PDF) of the BCN Provider Manual — Includes additional information on the utilization management requirements for these services. Look in the section titled "Managing PT, OT and ST / Managing physical medicine services"
- Outpatient rehabilitation services: Frequently asked questions (PDF)
- Tips about eviCore Authorizations for BCN Members (PDF)
- Suggestions for the Efficient Utilization of Therapy and Physical Medicine Services (PDF)
- Tips for improving treatment efficiency (PDF)
- Outpatient PT, OT and ST, and physical medicine services by chiropractors and athletic trainers: For authorization determinations (PDF) — Includes information about utilization management programs
- eviCore Physical Therapy Practitioner Performance Summary and Provider Category FAQs* (PDF)
- eviCore Practitioner Performance Summary and Utilization Management Categories* (PDF)
- U-M Premier Care Primary (Major) Diagnosis Codes for Therapies (PDF)
*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 healthcare® is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to manage prior authorizations for select services.