Provider Preauthorization and Precertification Requirements

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Provider Preauthorization and Precertification Requirements For Blue Cross PPO (commercial) and Medicare Plus BlueSM PPO members Revised Nov. 29, 2021 SPECIAL NOTE: Clinical review Requirements temporarily suspended for admissions to skilled nursing facilities from hospitals in certain states. See Section 4: Inpatient Admissions for more information. Table of Contents 1. Blue Cross Blue Shield of Michigan Definitions ........................................ ........................................ ................................... 2 2. Behavioral Health ........................................ ........................................ ........................................ ........................................ 2 Blue Cross Blue Shield of Michigan Commercial Products (Non-Medicare) ........................................ ........................ 2 Medicare Plus BlueSM PPO.

Precertification is not required for: • Outpatient services • Medicare primary contracts • Coordination of benefits contracts All inpatient partial and residential mental health and substance abuse facilities are required to notify New Directions for all admissions and discharges; most admissions will require a clinical review. You may

  Precertification, Requires