Carelon Medical Benefits Management manages prior authorizations for high-tech radiology services for:

• Blue Care Network commercial members
• BCN Advantage^SM members

For information about high-tech radiology services for Blue Cross Blue Shield of Michigan commercial and Medicare Plus Blue^SM members, see the Blue Cross Radiology Services, High Tech 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

• Procedure codes for which providers must request prior authorization (PDF) — See this document to determine which procedure codes require prior authorization
• Frequently asked questions about Carelon: for cardiology, radiology (high technology) and sleep studies (in lab) (PDF) — Answers to questions about prior authorization requirements for cardiology services, high-tech radiology services and in-lab sleep studies
• Radiology procedures (high-tech imaging): For prior authorization determinations (PDF) — Includes information about utilization management programs

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Carelon Medical Benefits Management is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to manage prior authorizations for select services.