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Care Management chapter of BCN Provider Manual

Contents care Management 2018 care ManagementBCN Provider ManualContentsHyperlinks to important information ..8-1 Overview of BCN Utilization Management ..8-2 Managing BCN members care ..8-5 The BCN referral process ..8-7 BCN authorization requirements ..8-18 Requests requiring clinical information ..8-24 Referrals and authorizations summary ..8-27 Procedures reviewed by eviCore for BCN ..8-30 Blue Elect Plus Self-Referral s Medicare products ..8-34 Other BCN products with Provider networks ..8-37 BCN 65 and secondary s Choice ..8-40 Guidelines for observations and inpatient hospital admissions ..8-41 Guidelines for transitional care ..8-49 Emergency room and urgent care services.

8-2 BCN Provider Manual March 2019 Chapter 8: Care Management Overview of BCN Utilization Management Scope of chapter This chapter applies to BCN HMOSM (commercial) products, BCN AdvantageSM HMO-POS products (group products and Basic, Classic, Elements and Prestige individual products) and BCN AdvantageSM HMO products (BCN Advantage SM HMO ConnectedCare, BCN …

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Transcription of Care Management chapter of BCN Provider Manual

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Changes from previous publication are marked with a Blue ...

ereferrals.bcbsm.com

Services That Require Authorization Authorization requirements for members with Blue Cross Medicare Plus BlueSM PPO or Blue Cross Medicare Plus BlueSM Group PPO coverage For more complete information about care management and utilization management requirements, refer to the Blue Cross Medicare Plus Blue PPO Provider Manual. Section 2: Codes for procedures that require authorization

  Services, Code, That, Authorization, Requires, Services that require authorization authorization

Service Contact Information - e-Referral

ereferrals.bcbsm.com

Blue Cross provider resource guide at a glance Find more information in the Blue Pages Directory chapter of the Blue Cross PPO Provider Manual: Visit bcbsm.com, log in to Provider Secured Services and click Provider Manuals.

  Guide, Provider, Resource, Provider resource guide at a

BCN Provider Resource Guide - e-Referral - Home

ereferrals.bcbsm.com

BCN Provider Resource Guide Welcome to the BCN Provider Resource Guide! In this guide you will find contact information for many of the services that BCN offers and for the functions you most frequently perform in caring for BCN members.

  Guide, Provider, Resource, Bcn provider resource guide

Service Contact Information - Blue Cross Blue Shield …

ereferrals.bcbsm.com

Blue Cross provider resource guide at a glance Find more information in the Blue Pages Directory chapter of the Blue Cross PPO Provider Manual: Visit bcbsm.com, log in to Provider Secured Services and click Provider Manuals.

  Guide, Directory, Provider, Blue, Resource, Provider resource guide at a

BCN Referral and Authorization Requirements

ereferrals.bcbsm.com

Changes from previous publication are identified by a Blue Dot and explained on the final page of this document. Page 1 of 10 Revised for June 1, 2018

  Referral, Bcn referral and

BCN Provider Inquiry Contact Information - e …

ereferrals.bcbsm.com

Provider Inquiry Contact Information For BCN HMOSM (commercial) and BCN AdvantageSM Behavioral Health For…During business hours…* After business hours… Physician-to-physician review of determination

  Information, Provider, Contact, Inquiry, Provider inquiry contact information

CT of the Abdomen OR CT Abdomen and Pelvis - e …

ereferrals.bcbsm.com

Radiology Questionnaire January 2014 . CT of the Abdomen OR CT Abdomen and Pelvis . Providers can expedite a request by submitting a prior authorization request through e-referral and completing the

  Abdomen, The abdomen or ct abdomen and

Blue Care Network e-referral User Guide

ereferrals.bcbsm.com

Dear Blue Care Network Health Care Service Provider: Welcome to e-referral on iEXCHANGE®, BCN’s Web-based referral and authorization system. Now that you have signed up to use e-referral, you are on

  Health, Guide, User, Network, System, Care, Referral, Blue, Blue care network e referral user guide, Blue care network health care

Detailed Explanation of Non-Coverage Instructions

ereferrals.bcbsm.com

Form Instructions for the Detailed Explanation of Non-Coverage (DENC) CMS-10124 . A Medicare provider/health plan (“plan”) must provide a completed copy of this notice to

  Coverage, Detailed, Explanation, Detailed explanation of non coverage

BCN Behavioral Health Continuing OTR Form - e …

ereferrals.bcbsm.com

BCN Behavioral Health Continuing Outpatient Treatment Request Form . Member number: Member name: Member DOB: Attach completed form to the case

  Health, Form, Behavioral, Continuing, Bcn behavioral health continuing otr form

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