Services that require authorization for Michigan providers

Changes from previous publication are marked with a Blue Dot and explained on the final page of this document. 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 1: authorization requirements authorization requests for non-urgent medical Services must be submitted at least 14 days prior to Services being rendered. Note: This list is not all-inclusive. In addition, authorization of a service based on the clinical information provided does not guarantee payment.

• Cardiac resynchronization therapy • Implantable cardioverter -defibrillator Arterial ultrasound Cosmetic or reconstructive surgery . See also: • Blepharoplasty • Rhinoplasty • Septoplasty Prior authorization is required for certain procedure codes. Use the e- referral system to submit the request and complete the

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  Authorization, Therapy, Cardiac, Resynchronization, Cardiac resynchronization therapy

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