We're aligning peer-to-peer review request processes for acute non-behavioral health non-elective inpatient admissions

For acute non-behavioral health non-elective inpatient admissions, the process for requesting a peer-to-peer review with a Blue Cross Blue Shield of Michigan or Blue Care Network medical director is now the same for all lines of business. This applies to inpatient admission authorization requests denied for Blue Cross' PPO, Medicare Plus BlueSM PPO, BCN HMO^SM and BCN Advantage^SM members.

Here's what you need to know about peer-to-peer review requests for acute non-behavioral health non-elective inpatient admissions:

• Submit all requests using the Physician peer-to-peer request form (for non-behavioral health cases). Complete the form and fax it to 1-866-373-9468 during normal business hours of 8 a.m. to 5 p.m. Eastern time (except weekends and holidays).

Note: We'll outreach to you the next business day. The peer-to-peer review will be scheduled on business days, Monday through Friday between 9 a.m. and 4 p.m. Eastern time (except holidays).

• Using the form is optional for now but will be mandatory starting Jan. 1, 2020.

Note: Currently, for Blue Cross' PPO and Medicare Plus Blue requests, you call 1-866-346-7299 to request a peer-to-peer review. However, on Jan. 1, 2020, that number will be taken out of service.

• The request process is not changing for BCN HMO and BCN Advantage. Currently, you submit BCN requests using the form. It's the process for Blue Cross' PPO and Medicare Plus Blue requests that's changing.
• The form is available on this website, on the Blue Cross Authorization & Requirements & Criteria page and the BCN Authorization & Requirements & Criteria page. The form has been updated for use with all lines of business.

Additional information

For information about requesting peer-to-peer reviews on denied authorization requests for various types of services, refer to the description of the process in the document How to request a peer-to-peer review with a Blue Cross or BCN medical director. This document is also available on the Blue Cross and BCN Authorization Requirements & Criteria pages on this website.

The only process that's changing is the one for requesting acute non-behavioral health non-elective inpatient admissions. The processes for requesting peer-to-peer reviews for other types of services are staying the same.