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Cardiology Services

Prior authorizations for cardiology services are managed as follows.

Service	Members	Managed by
Cardiology	Blue Cross Blue Shield of Michigan commercial fully insured groups and individual members for dates of service on or after Sept. 1, 2023 Medicare Plus Blue^SM members	Carelon Medical Benefits Management
Select cardiology services	Blue Care Network commercial BCN Advantage^SM	BCN Utilization Management — Submit through the e-referral system
Various cardiology services, including echocardiology	Blue Care Network commercial BCN Advantage	Carelon Medical Benefits Management
Echocardiology	Blue Cross commercial Fully insured group and individual members Self-funded groups — Exceptions: See the Carelon exclusion list for Blue Cross Blue Shield of Michigan Commercial to learn about the health plans, groups, and settings and scenarios for which prior authorization isn't required. Medicare Plus Blue members	Carelon Medical Benefits Management

How to submit prior authorization requests

To learn how to submit requests, see our Getting Started page.

Submit requests before providing services.

Shared Resources

Resources for services managed by Carelon

Procedures that require prior authorization by Carelon: Cardiology, radiation oncology, radiology (high technology) and sleep studies (in lab)
Frequently asked questions about Carelon: for cardiology, radiology (high technology) and sleep studies (in lab) — Answers to questions about authorization requirements for cardiology services, high-tech radiology services and in-lab sleep studies
Carelon's Clinical guidelines and pathways*

Additional Resources

Blue Cross and BCN medical policies — Open our Medical Policy Router Search page on bcbsm.com. Enter a procedure code in the Policy/Topic Keyword field.
Cardiology: For home monitoring and cardiology and echocardiology procedures —Includes information about care management and utilization management programs

BCN Resources

Utilization Management chapter of the BCN Provider Manual
BCN Advantage chapter of the BCN Provider Manual
BCN referral and authorization requirements for Michigan providers

*Clicking this link means that you're leaving the Blue Cross Blue Shield of Michigan and Blue Care Network website. While we recommend this site, we're not responsible for its content.

Carelon Medical Benefits Management is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to manage prior authorizations for select services.