Acute Inpatient Medical and Surgical Admissions
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Blue Cross Blue Shield of Michigan manages prior authorizations for acute inpatient medical and surgical admissions (non-behavioral health) for:
- Blue Cross Blue Shield of Michigan commercial
- Medicare Plus BlueSM
Blue Care Network manages prior authorizations for acute inpatient medical and surgical admissions (non-behavioral health) for:
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- BCN AdvantageSM
Clinical Criteria:
- For dates of service on or after Aug. 1, 2023, we use InterQual® criteria to make authorization determinations on acute inpatient medical and surgical admissions for adults. There are no local rules.
- Note: For dates of service from March 1, 2022, through July 31, 2023, we used the 2022 Blue Cross and BCN Local Rules for acute inpatient medical admissions of adults care
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For more information, see this frequently asked question document.
How to submit prior authorization requests
To learn how to submit requests, see our Getting Started page.
Submit requests before providing services.
Training for acute care inpatient hospitals in Michigan on requesting peer-to-peer reviews and appeals
We offer provider training. To learn more, see our Training Tools page.
Shared Resources
- Submitting acute inpatient authorization requests: Frequently asked questions for providers
- Holiday closures: How to submit authorization requests for inpatient admissions
- How to request a peer-to-peer review with a Blue Cross or BCN medical director
- Physician peer-to-peer request form (for non-behavioral health cases)
- Acute inpatient admissions: For authorization determinations — Includes information about our utilization management program
- Acute inpatient hospital assessment form
Medicare Advantage Resources
- Medicare Advantage inpatient assessment form
- See the FFS & MA IM webpage* on the cms.gov website to access the following:
- Important Message from Medicare
- Detailed Notice of Discharge
- For patients in observation:
BCN Resources
Frequently accessed documents
Additional resources
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