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Provider Preauthorization and Precertification Requirements

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 .. 3 3. Human Organ Transplants.

treatment admissions or extensions require preauthorization and concurrent review. ... requests may delay the processing of the authorization, however Blue Cross will attempt to reach out to obtain the additional information if a clinical review cannot be completed.

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