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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).

additional requirements may be needed prior to requesting a precertification. Please contact FEP benefits at 800-482-3600. Requests for enhancements for skilled nursing facilities, long term acute care hospitals and fifth-level hospice for commercial contracts are processed within Blue Cross Precertification Services.

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