Acute Inpatient Medical and Surgical Admissions
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 Blue℠
Blue Care Network manages prior authorizations for acute inpatient medical and surgical admissions (non-behavioral health) for:
- Blue Care Network commercial
- BCN Advantage℠
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
.
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.
Frequently accessed documents
Additional resources
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