Reminder: Starting March 1, we aligned our Local Rules for acute inpatient medical admissions
As a reminder, for acute inpatient medical admissions of members with certain conditions, authorization requests should be submitted only after the member has spent two days in the hospital.
This update to our Local Rules went into effect for all members admitted to Michigan hospitals on or after March 1, 2022. This includes Blue Cross Blue Shield of Michigan and Blue Care Network commercial members, as well as Medicare Plus BlueSM and BCN AdvantageSM members.
Note: For non-Michigan hospitals, this update to our Local Rules applies only to Medicare Plus Blue members.
About observation orders
Some hospitals have asked whether an observation order is required when billing Blue Cross or BCN for observation.
Blue Cross and BCN don't require an observation order when reimbursing an observation claim. This applies to all lines of business - that is, to Blue Cross Blue Shield of Michigan commercial, Medicare Plus Blue, BCN commercial and BCN Advantage.
Additional information
For other important details about this change, refer to these documents:
- Blue Cross and BCN Local Rules for 2022 (non-behavioral health) (PDF)
- Blue Cross and BCN Local Rules: Frequently asked questions (PDF)
We communicated about this change earlier, in our provider newsletters. Refer to these articles:
- February 2022 issue of The Record
- March-April 2022 issue (PDF) of BCN Provider News, on pages 18 and 19
Posted: March 2022
Lines of business: Blue Cross Blue Shield of Michigan and Blue Care Network