How to request peer-to-peer review of inpatient admissions

Blue Cross Blue Shield of Michigan and Blue Care Network allow onsite physician advisors at contracted facilities to discuss reviews of inpatient admissions with a Blue Cross or BCN medical director. According to our policy, facilities should start peer-to-peer conversations only through their employed physician advisors, and not through third-party advisors or organizations.

This applies to members with coverage with Blue Cross PPO (commercial), BCN HMO^SM (commercial), Blue Cross Medicare Plus Blue^SM PPO and BCN Advantage^SM products.

The purpose of the peer-to-peer discussion is to exchange information about the clinical nuances of the member's medical condition and the medical necessity of the inpatient admission, not to discuss InterQual^® criteria or Blue Cross and BCN local rules.

The peer-to-peer phone lines are open Monday through Friday, 8 a.m. to 5 p.m. Eastern time, except for holidays. We'll return your call within 48 business hours.

Use the following guidelines to request a peer-to-peer review with a Blue Cross or BCN medical director.

Non-behavioral health inpatient admissions

For BCN HMO (commercial) and BCN Advantage members:

1. Call 248-799-6312.
2. Select prompt 3 for a peer-to-peer discussion.
3. Leave a message that includes the:
• Reason for requesting a peer-to-peer review
• Member's name, date of birth and contract number
• Physician advisor's or physician's name and phone number
• Best date and time to reach the physician advisor or physician

For Blue Cross PPO (commercial) and Medicare Plus Blue members:

1. Call 1-866-346-7299.
2. Select prompt 2 for the Facility Precertification department
3. Select prompt 1 to request a provider peer-to-peer review.
4. Wait for the prompt to leave a message, then provide the:
• Reason for requesting a peer-to-peer review
• Member's name, date of birth and contract number
• Physician advisor's or physician's name and phone number
• Best date and time to reach the physician advisor or physician

Behavioral health inpatient admissions

For BCN HMO (commercial), BCN Advantage and Medicare Plus Blue members:

1. Call 1-877-293-2788.
2. If a live operator doesn't answer the call, leave a message that includes the:
• Name of the person calling and a call-back number
• Member's name, date of birth and contract or case number
• Specific times the provider is available to discuss the case
• Physician advisor's or physician's name and phone number

For Blue Cross PPO (commercial) members: Call the behavioral health number on the back of the member's ID card.

Posted: July 2018
Lines of business: Blue Cross Blue Shield of Michigan and Blue Care Network