How to submit BCN inpatient authorization requests during upcoming holiday closures

Blue Cross Blue Shield of Michigan and Blue Care Network corporate offices are closed on the following days:

• Monday, Sept. 3, 2018 (Labor Day holiday)
• Tuesday, Nov. 6, 2018 (Election Day holiday)

During these holiday closures, BCN's inpatient utilization management area remains available to accept inpatient authorization requests for BCN HMO^SM (commercial) and BCN Advantage^SM members.

Here's what you need to know about submitting inpatient authorization requests to BCN when our corporate offices are closed.

Acute initial inpatient admissions. Submit these authorization requests through the e-referral system, which is available 24 hours a day, seven days a week.

Note: These requests may also be submitted through the X12N 278 Health Care Services Review – Request for Review and Response electronic standard transaction.

Post-acute initial and concurrent admission reviews. Follow the current process you use to submit these requests by fax at 1-866-534-9994.

Other authorization requests. The types of requests listed below must be submitted by fax. For these requests, faxes are processed only Mondays through Friday. They are not processed on weekends or on the holidays on which BCN is closed. Fax BCN HMO (commercial) requests to 1-866-313-8433. Fax BCN Advantage requests to 1-866-526-1326.

• Acute inpatient concurrent reviews and discharge dates, but only for facilities reimbursed on the basis of DRGs
• Authorization requests for sick or ill newborns
• Authorization requests for enteral and total parenteral nutrition

Additional information. You can also call the BCN After-Hours Care Manager hotline at 1-800-851-3904 and listen to the prompts for help with the following:

• Determining alternatives to inpatient admissions and triage to alternative care settings
• Arranging for emergency home health care, home infusion services and in-home pain control
• Arranging for durable medical equipment
• Handling emergency discharge planning coordination and authorization
• Handing expedited appeals of utilization management decisions

Note: Do not use the after-hours care manager phone number to request authorization for routine inpatient admissions.

Refer to the document Submitting acute inpatient admission requests to BCN for additional information.

As a reminder, when an admission occurs through the emergency room, we ask that you contact the primary care physician to discuss the member's medical condition and coordinate care prior to admitting the member.

Posted: August 2018
Line of business: Blue Care Network