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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 .. 4 Blue Cross Blue Shield of Michigan commercial Products (Non-Medicare) .. 4 Medicare Plus BlueSM PPO .. 4 4. Inpatient Admissions .. 5 Blue Cross Blue Shield of Michigan commercial Products (Non-Medicare) .. 5 Medicare Plus BlueSM PPO .. 8 5. Medical Benefit Drugs .. 11 Blue Cross Blue Shield of Michigan PPO ( commercial ) and Medicare Plus BlueSM PPO Products.

• E-referral Electronic system for Michigan providers to submit requests for inpatient admission. ... Note: If you fail to submit your authorization request, submit an untimely request or your request is ... • Commercial PPO LTAC/SNF Enhancement Form Providers can call 1-800-249-5103 to obtain a status on Precertification requests by ...

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