bcbs michigan inpatient prior authorization form


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PDF Provider Overview

• Pre-service or prior authorization is obtained – unauthorized transitions should be rare and justified • Acute Care provider secures the authorization

PDF Provider preauthorization and precertification requirements

23 jan 2024 · Providers can submit prior authorization requests for Blue Cross Blue Shield of Michigan Contracted Michigan provider acute inpatient 

PDF State Health Plan Medicare Advantage Benefits

• In November Blue Cross will mail a pre-enrollment packet to members Prior authorization for certain services is key to making sure you receive 

PDF MESSAs list of services requiring mandatory prior authorization

Inpatient residential or partial hospital (non-participating facility) Yes Blue Cross Behavioral Health Refer to Blue Cross Blue Shield of Michigan 

PDF BLUE CROSS BLUE SHIELD OF MICHIGAN PLAN

PRIOR AUTHORIZATION REQUIRED Prior authorization is a drug class management technique that requires select prescriptions to meet defined criteria before 

PDF Blue Cross Complete of Michigan authorization requirements

Inpatient admissions Services require authorization This includes long-term acute care inpatient rehabilitation and skilled nursing care Blue Cross Complete 

PDF Acute inpatient hospital assessment form

Complete this form and submit it along with supporting clinical documentation when requesting authorization for admissions to and extensions of stays at acute 

PDF Your Benefit Guide

The inpatient admission and length of stay must be medically necessary and pre-approved The claim form is available from your BCBSM Service Center the 

  • When submitting either of these forms to BCBSTX, please use the following applicable fax # or address: Fax 888-579-7935.
    If unable to fax, mail to: BCBSTX, P.O.
    Box 660044, Dallas, TX 75266-0044.

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Blue Cross Blue Shield Of Michigan Prior Authorization Form Pdf

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