Here's how to choose the correct servicing provider in e-referral to avoid denied claims

To avoid any problems when submitting authorizations and referrals in e-referral, we're clarifying the steps for choosing the correct servicing provider.

Keep in mind that the provider you’re looking for may be listed multiple times. Here's how to make sure you're choosing the correct listing:

1. When your servicing provider results are returned, select the listing based on where the member is going to see the provider.

2. If the provider has several listings with the same address, select the listing that also shows a group affiliation. If there are multiple group affiliations listed, make sure to choose the correct one.
3. Not all provider addresses will be considered in network. If you select a listing that shows the provider is out of network ("Out" in the Network column), you'll have to go through an out-of-network review.

This information, including screen examples, can be found in the following sections of the e-referral user guides:

• e-referral User Guide (PDF)
  • "Submit a Global Referral"
  • "Submit a Referral"
  • "Submit an Inpatient Authorization"
  • "Submit an Outpatient Authorization"
• Behavioral Health e-referral User Guide (PDF)
  • "Submitting Higher Levels of Care Inpatient Authorizations"
  • "Submitting Higher Levels of Care Outpatient Authorizations"
  • "Submitting an Electroconvulsive Therapy Authorization"
  • "Submitting a Transcranial Magnetic Stimulation Authorization"
  • "Submitting a Neurofeedback Authorization"
• e-referral User Guide for Blue Cross^® Physician Choice PPO (PDF)
  • "Submit a Referral"
  • "Submit an Inpatient Authorization"

It can also be found in the e-referral Quick Guide (PDF) under the "Select provider/patient" section. This information is also published on Page 30 of the July-August 2021 BCN Provider News (PDF) and the July 2021 issue of The Record.

Posted: July 2021
Lines of business: Blue Cross Blue Shield of Michigan and Blue Care Network