July 2024
Guidelines for billing Avastin for Blue Cross and BCN commercial members (PDF)
Epysqli to require prior authorization for most commercial members starting Aug. 8 (PDF)
Changes to the BCN referral and authorization requirements for Michigan providers document (PDF)
Rytelo will require prior authorization for Medicare Advantage members starting Aug. 1 (PDF)
Updated TurningPoint medical policies for musculoskeletal and pain management procedures (PDF)
Kisunla to require prior authorization for most commercial members starting July 18 (PDF)
e-referral system unavailable on two weekends in July (PDF)
June 2024
Yimmugo and Piasky to require prior authorization for most commercial members starting July 11 (PDF)
July 4-5 holiday closure: How to submit authorization requests for inpatient admissions (PDF)
Utilization management phone closed on June 28 until 1 p.m. (PDF)
Questionnaire changes in the e-referral system starting June 23 (PDF)
Lamzede and Vyjuvek to have requirements for URMBT members with Blue Cross non-Medicare plans (PDF)
June 19 holiday closure: How to submit authorization requests for inpatient admissions (PDF)
e-referral system out of service for maintenance overnight June 15-16 (PDF)
Beqvez will have additional requirements for most commercial members (PDF)
Vyjuvek will have additional requirements for most commercial members starting July 22 (PDF)
Bkemv to require prior authorization for most commercial members starting June 13 (PDF)
Alyglo has requirements for Federal Employee Program non-Medicare members as of June 1 (PDF)
Changes coming for select weight loss drugs for some commercial members (PDF)
Soliris and Ultomiris to have a step therapy requirement for commercial members (PDF)
May 2024
Opuviz and Yesafili to require prior authorization for most commercial members starting June 6 (PDF)
Hemlibra to have a quantity limit requirement for most commercial members (PDF)
Changes to the Hyperbaric oxygen therapy questionnaires in the e-referral system (PDF)
Step therapy requirement added for Saphnelo for Medicare Advantage members starting Sept. 1 (PDF)
May 27 holiday closure: How to submit authorization requests for inpatient admissions (PDF)
New information about Winrevair SC for commercial members (PDF)
We’ll use 2024 InterQual criteria starting Aug. 1 (PDF)
Loqtorzi to have requirements for most members starting Aug. 15 (PDF)
Beqvez will require prior authorization for Medicare Advantage members starting June 1 (PDF)
e-referral system unavailable on two weekends in May (PDF)
Update: Beqvez to require prior authorization for most commercial members starting May 9 (PDF)
April 2024
Pemfexy and Pemrydi RTU to have additional step therapy requirements for most members (PDF)
Hercessi to require prior authorization for most commercial members starting May 16 (PDF)
Guidelines for using the Autism diagnostic evaluation results form (PDF)
Omvoh SC and IV to have a step therapy requirement for most commercial members starting June 3 (PDF)
Update: Spevigo SC to have requirements for most commercial members starting April 25 (PDF)
e-referral system out of service for maintenance overnight April 20-21 (PDF)
Amtagvi will have additional requirements for most commercial members, starting May 28 (PDF)
Procedure codes that require prior authorization through BCN (PDF)
Cosentyx IV to have a site-of-care requirement for most commercial members starting July 1 (PDF)
Update: Winrevair to require prior authorization for Medicare Advantage members starting May 1 (PDF)
Vyjuvek to have a site-of-care requirement for most commercial members starting April 4 (PDF)
March 2024
Questionnaire changes in the e-referral system starting March 31 (PDF)
March 29 holiday closure: How to submit authorization requests for inpatient admissions (PDF)
Lenmeldy to require prior authorization for most commercial members starting March 28 (PDF)
Tofidence will require prior authorization for Medicare Advantage members starting May 1 (PDF)
Elrexfio and Talvey to require prior authorization for most members starting June 20 (PDF)
Explanation of lifestyle modification for weight loss drugs (PDF)
e-referral system out of service for maintenance overnight March 16-17 (PDF)
Update: Preferred product for Zynteglo for most commercial members starting April 19 (PDF)
We’re changing how we manage Entyvio SC and Omvoh SC, starting March 1 (PDF)
February 2024
Medicare Plus Blue PPO Provider Manual update coming in April 2024 (PDF)
Update: Prior authorization requests for behavioral health services (PDF)
Update: Amtagvi to require prior authorization for most commercial members starting Feb. 29 (PDF)
e-referral system out of service for maintenance overnight Feb. 17-18 (PDF)
Don’t submit referrals for members with BCN point-of-service plans (PDF)
January 2024
We’re no longer mailing some letters related to Medicare Advantage inpatient admissions (PDF)
Pemfexy to have step therapy requirements starting April 26 (PDF)
Omvoh to have a site-of-care requirement for most commercial members starting May 1 (PDF)
Updated: Entyvio, Omvoh and Wezlana to require prior authorization for most commercial members (PDF)
Questionnaire changes in e-referral starting Jan. 28 (PDF)
Starting March 1, some continuous glucose monitor products will require prior authorization (PDF)
Updated: Alyglo to require prior authorization for most commercial members starting Jan. 18 (PDF)
Cabenuva to have requirements for most commercial members starting May 1 (PDF)
e-referral system out of service for maintenance overnight Jan. 20-21 (PDF)
Continuity of care arrangements are expanded to Medicare Advantage members (PDF)
Requirements changing for some medical benefit drugs for Medicare Advantage members (PDF)
January 2, 2024: Changes to ereferrals.bcbsm.com (PDF)
Jan. 15 holiday closure: How to submit authorization requests for inpatient admissions (PDF)
December 2023
December 28, 2023: Changes to ereferrals.bcbsm.com (PDF)
December 5, 2023: Changes to ereferrals.bcbsm.com (PDF)
NaviHealth to change its name to Home & Community Care (PDF)
Updated: Two changes for the services managed by Blue Cross Behavioral Health (PDF)
Avzivi and Ryzneuta to require prior authorization for most commercial members starting Jan. 1 (PDF)
Prior authorization requests for Makena for Federal Employee Program members (PDF)
Rystiggo to have a site-of-care requirement for most commercial members starting April 1 (PDF)
Casgevy and Lyfgenia to require prior authorization for most commercial members (PDF)
Letters to providers will include reason BCN admissions were bundled (PDF)
e-referral system out of service for maintenance overnight Dec. 16-17 (PDF)
New labor contract ratified by UAW at Blue Cross Blue Shield of Michigan and Blue Care Network (PDF)
Medicare Advantage provider servicing wait times (PDF)
Step therapy requirement to be added for Soliris and Ultomiris for Medicare Advantage member (PDF)
Additional drugs to have requirements for URMBT members with Blue Cross non-Medicare plans (PDF)
November 2023
Update: Additional medical oncology drugs to have requirements for most members (PDF)
How autism treatment authorizations will continue into 2024 (PDF)
How to submit clinical information to Carelon when requesting prior authorization (PDF)
Questionnaires changes in the e-referral system starting Nov. 26 (PDF)
Nov. 23-24 holiday closure: How to submit inpatient authorization requests (PDF)
Adzynma to require prior authorization for most commercial members (PDF)
e-referral system out of service for maintenance overnight Nov. 18-19 (PDF)
Updated: Entyvio, Omvoh and Wezlana to require prior authorization for most commercial members (PDF)
November 10, 2023: Changes to ereferrals.bcbsm.com (PDF)
Changes to prior authorization request process for varicose vein procedures (PDF)
New and updated questionnaires in e-referral system starting Nov. 5 (PDF)
More information about the Jan. 1 behavioral health changes (PDF)
Omisirge to require prior authorization for Medicare Advantage members starting Feb. 1 (PDF)
October 2023
October 24, 2023: Changes to ereferrals.bcbsm.com (PDF)
October 12, 2023: Changes to ereferrals.bcbsm.com (PDF)
Cosentyx IV to require prior authorization for most commercial members (PDF)
Changes to infliximab step therapy requirements for Medicare Advantage members (PDF)
Updated: For commercial LTACH requests, questionnaire will open in e-referral system (PDF)
Tecvayli will have additional requirements for most commercial members, starting Dec. 7 (PDF)
We’ll use updated 2023 InterQual criteria starting Feb. 1 (PDF)
Update: Beyfortus will have limits for commercial members, starting Jan. 1 (PDF)
e-referral system out of service for maintenance overnight Oct. 21-22 (PDF)
Carelon won’t manage home sleep studies starting Jan. 1 (PDF)
Pombiliti, Rivfloza and Tofidence to require prior authorization for most commercial members (PDF)
Updated questionnaires in the e-referral system starting Oct. 15 (PDF)
Upcoming changes to the TurningPoint provider portal (PDF)
Vyvgart Hytrulo to have a site-of-care requirement for most commercial members starting Jan. 1 (PDF)
Updated reminder: Changes for in-lab sleep studies to start Oct. 9 (PDF)
September 2023
Management of outpatient diabetes supplies for additional members starting Jan. 1 (PDF)
Reminder: Facilities must submit appeals within the required time frames (PDF)
Reminder: Additional services require prior authorization through Carelon (PDF)
Starting Oct. 1, 2023, we’ll change prior authorization criteria for some weight loss drugs (PDF)
New and updated questionnaires in the e-referral system starting Sept. 24 (PDF)
Prior authorization no longer required for some procedures, starting Jan. 1 (PDF)
Daxxify to require prior authorization for Medicare Advantage members starting Dec. 18 (PDF)
e-referral system out of service for maintenance overnight Sept. 16-17 (PDF)
Zynyz to require prior authorization for most members starting Dec. 10 (PDF)
Lumoxiti will no longer require prior authorization starting Sept. 30 (PDF)
Update: Advance notice requirements for noncovered services by independent and hospital labs (PDF)
Updated Orthoptic and pleoptic visual training questionnaire in e-referral system (PDF)
Tyruko to require prior authorization for most commercial members starting Sept. 14 (PDF)
August 2023
Medicare Plus BlueSM PPO Provider Manual update coming in October 2023 (PDF)
Veopoz, Eylea HD and Daxxify to require prior authorization for most commercial members (PDF)
Sept. 4 holiday closure: How to submit inpatient authorization requests (PDF)
Prior authorization changes for varicose vein treatments (PDF)
New and updated questionnaires in the e-referral system starting Aug. 27 (PDF)
Requirements for prior authorization of Omisirge (PDF)
Lantidra and Rethymic to require prior authorization for most commercial members (PDF)
Starting Sept. 1, we’ll require prior authorization for some diabetes drugs (PDF)
Izervay to require prior authorization for most commercial members (PDF)
e-referral system out of service for maintenance overnight Aug. 19-20 (PDF)
July 2023
Update: Changes for in-lab sleep studies to start Oct. 9 (PDF)
Updated questionnaires in the e-referral system (PDF)
For commercial LTACH requests, submit information about three SNFs to avoid delays (PDF)
Rystiggo® and Vyvgart® Hytrulo to require prior authorization for most commercial members (PDF)
e-referral system out of service for maintenance overnight July 15-16 (PDF)