Transcription of Provider Preauthorization and Precertification Requirements
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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.
dependency treatment must obtain prior authorization by calling BCBSM Medicare Plus Blue PPO Behavioral Health Department at 888-803-4960 or by faxing 866-315-0442. BCBSM Medicare Plus Blue PPO Behavioral Health Department case managers are available 24 hours per day, seven days a week for inpatient admissions and member emergencies.
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