BCN Provider Resource Guide - Blue Cross Blue Shield of ...

1 BCN Provider Resource Guide Behavioral Health Welcome to the BCN Provider Resource Guide ! Benefits and Eligibility In this Guide you will find contact information for many of the services that BCN offers Care Management and for the functions you most frequently perform in servicing BCN members. Chronic Condition Use the navigation bar at the left to go directly to the information for specific topics. Management Use the Next and Previous buttons at the lower right to navigate forward or backward Claims in the document. Coordination of Benefits The pages in this Guide are updated on an as-needed Customer Service basis. The date shown in the lower left corner of the text reflects the date on which the information on that page DME, Medical Supplies was last revised.

2 If you print any pages from the and P&O. Guide , be sure to check back for updates. Health & Wellness You can search the Guide for a specific topic Laboratory Services by inserting one or more keywords into the Pharmacy Services Find field immediately above the Guide and pressing Enter. PT, OT and ST. If there is other information you Provider Consultants feel should be added to the Provider Enrollment and Guide , be sure to let us Change Requests know by contacting us at Provider Inquiry Quality Management Travel and Guest Member Services Previous Next | Behavioral Health (Mental Health / Substance Use Disorders). Behavioral Health Primary care physicians are not Provider Inquiry - Behavioral Health responsible for arranging, referring Benefits and Eligibility or authorizing behavioral health During business After business Care Management services.

3 Primary care physicians * *. may, however, directly refer Physician-to-physician Phone: 1-877-293-2788 Phone: 1-800-482-5982. Chronic Condition a member to a BCN-affiliated review of determination Management behavioral health Provider . It is (Physician Review Line). not necessary for the primary care Member with BCN Phone: 1-888-265-4703 Calls are answered only Claims physician to provide a written referral coverage who is a Blue Fax: 1-844-318-5145 during ombudsman to the behavioral health Provider . Cross employee business hours. Coordination of Benefits The behavioral health Provider must Member with BCN Phone: 1-800-482-5982 Phone: 1-800-482-5982. Customer Service contact the plan for an authorization.

4 Coverage who is not a Fax: 1-866-364-7145. Blue Cross employee Primary care physicians may DME, Medical Supplies call BCN Behavioral Health for Member with BCN Phone: 1-800-431-1059 Phone: 1-800-431-1059. and P&O assistance in arranging behavioral AdvantageSM coverage Fax: 1-866-364-7145. health services for a BCN member. Member with coverage Phone: 1-888-312-5713 Phone: 1-888-312-5713. Health & Wellness through Blue Cross Fax: 1-888-987-6395. Members in need of behavioral Complete of Michigan Laboratory Services For more information about Blue Cross Complete, health services may either contact visit an affiliated behavioral health Pharmacy Services Provider directly or call the telephone *Business hours for BCN Behavioral Health are Monday Friday (except PT, OT and ST number located on the back of their holidays) 8 to 5 except for the ombudsman phone (1-888-265-4703), member identification card.

5 Which is open 8:30 to 5 Provider Consultants Note: For Provider inquiry information related to questions other than Mailing address (for claims) behavioral health services, refer to the Provider Inquiry (non-behavioral Provider Enrollment and BCN HMOSM / BCN AdvantageSM. Change Requests health) page in this Guide . Behavioral Health Department Box 68753 Web Provider Inquiry Grand Rapids, MI 49516-8753 For information on authorizations: Quality Management Visit > BCN > Behavioral Health. For additional information on behavioral health services: Travel and Guest Member Visit > Login > BCN Provider Publications and Services Resources > Behavioral Health. Previous Home Next | August 2017.

6 Benefits and Eligibility Behavioral Health Providers can use one of the web-DENIS PARS. methods outlined on this page to Computer-based system Automated telephone system Benefits and Eligibility check a member's: Care Management Eligibility Telephone Telephone Benefits To activate or for technical Facility providers: Chronic Condition Copayments and assistance: 1-877-258-3932 1-800-249-5103. Management deductibles Professional providers: Business hours 1-800-344-8525. Primary care physician Claims Monday Friday (except holidays) Hearing / vision providers: assignment 8 to 8 1-800-482-4047. Coordination of Benefits Web Business hours Customer Service To register: 24 hours per day / 7 days per week Visit >.

7 DME, Medical Supplies Provider Secured Services. Web and P&O Select the appropriate Provider Visit >. type under the Michigan Contact us (under Help) > Provider Health & Wellness providers and facilities: How to Automated Response System Laboratory Services get access heading and follow (PARS). the instructions. Pharmacy Services To log in: Provider Inquiry Visit > Find Provider Inquiry and PARS. PT, OT and ST LOGIN > web-DENIS. phone and fax numbers for all Provider Consultants products on the Provider Inquiry Pharmacy Contact Information list. Provider Enrollment and For pharmacy inquiries related to Change Requests benefits / eligibility, see the Provider Inquiry page in this Guide .

8 Provider Inquiry Web Quality Management Visit > Quick Links > Pharmacy Services. Travel and Guest Member Services Previous Home Next | December 2017. Care Management Behavioral Health Care Management performs the following services: Telephone / fax numbers Case, chronic condition and utilization Benefits and Eligibility Contact information management, including: Requests for IP admissions (with Phone: 1-855-724-4285. Care Management - Acute IP admissions / concurrent reviews clinical information) Fax: 1-866-526-1326 or (Facilities are required to notify BCN within one 1-866-313-8433. Chronic Condition business day of an acute inpatient admission.). Requests for home care services Phone: 1-800-392-2512.

9 Management - Rehabilitation admissions (with clinical information) Fax: 1-866-526-1326 or - SNF and LTACH admissions Claims 1-866-313-8433. - Home care services (out-of-network requests for Requests for SNF / rehab / LTACH Phone: 1-855-724-4286. Coordination of Benefits all members; in-network requests for URMBT. services (with clinical information) Fax: 1-866-534-9994. members only). Other requests for clinical review Phone: 1-800-392-2512. Customer Service - Home TPN and enteral feedings (with clinical information) Fax: 1-800-675-7278. Note: All requests must include clinical information. DME, Medical Supplies - Referral management Expedited Provider appeals Phone: 248-799-6312.

10 And P&O Review of potential quality variances and serious Provider requests for criteria Phone: 248-799-6312. adverse events (during business hours). Health & Wellness Transplant evaluations Reaching Care Management staff Phone: 1-800-392-2512. Laboratory Services Social work services Review of Provider appeals Pharmacy Services Other contact information Call After Hours Care Manager (1-800-851-3904) to: Mailing address for general inquiries PT, OT and ST Determine alternatives to inpatient admissions Blue Care Network, Care Management Arrange for DME and for emergent home health/ Mail Code C336 Box 5043. Provider Consultants Southfield, MI 48086-5043. home infusion services and in-home pain control Provider Enrollment and Plan / coordinate / authorize emergent discharges Mailing address for appeals Change Requests Initiate an expedited Provider appeal Blue Care Network Discuss urgent / emergent determinations with a ATTN: Provider Appeals, Care Management Provider Inquiry plan medical director Mail Code C336 Box 5043.