How do I file an appeal with BCBS of Michigan?
You can use the Member Appeal Form (PDF) to submit your appeal. The form is optional. You can use it by itself or with a formal letter of appeal. You can select someone to act on your behalf at any step of the grievance and appeals process, including your physician.
How do I get authorization from BCBS of Michigan?
Requests for authorization for BCBS Michigan members can be submitted directly through your local Blue plans electronic portal via the Electronic Provider Access system (EPA). BCBSM encourages the use of the Electronic Provider Access system (EPA) to effectively and efficiently respond to your request.
Does BCBS of Michigan require prior authorization?
BCBSM requires prior authorization for services or procedures that may be experimental, not always medically necessary, or over utilized. Providers must submit clinical documentation in writing explaining why the proposed procedure or service is medically necessary.
What is timely filing for BCBS Michigan?
All claims must be submitted within the required filing deadline of 365 days from the date of service.
What is the difference between prior authorization and step therapy programs?
Automation of prior authorization for medications is referred to as electronic prior authorization. Step therapy is an insurance protocol that requires patients to try one or more insurer-preferred medications prior to a physician recommendation. This practice is also known as “fail first” and can take weeks or months.
Who is the specialty pharmacy for BCBS of Michigan?
AllianceRx Walgreens PharmacyBlue Cross Blue Shield of Michigan and Blue Care Network also offers home delivery and support programs through AllianceRx Walgreens Pharmacy, an independent company that provides specialty pharmacy services for Blue Cross and BCN members.
Does CPT 78452 require authorization?
The provider does not need to contact Care to Care to modify the authorization as CPT code 78452 is included in the same code group as CPT code 78451. Example #2: An authorization is given for CPT code 78453 “Myocardial perfusion imaging, planar; single study, at rest or stress”.
Does CPT 43239 require authorization?
There must be a valid Medical Necessity for a prior authorization number, and all forms must be fulfilled. The claim may be rejected if the prior authorization number is not submitted. While performing EGD with biopsy (CPT 43239), moderate sedation is required to ease the procedure.
What is CVS NovoLogix?
NovoLogix is a cutting-edge Medical Pharmacy Management(MPM) product. Our information system and services platform creates customizable, PBM-like capabilities, which effectively and efficiently manage drugs covered under the medical benefit. -
What is the difference between Blue Care Network and Blue Cross Blue Shield of Michigan?
Blue Care Network of Michigan is a nonprofit health maintenance organization. We're owned by Blue Cross Blue Shield of Michigan. We've been around since 1998. We have more than 840,000 members.
Is BCBS of Michigan on availity?
Availity Essentials is now Blue Cross® Blue Shield® of Michigan and Blue Care Network's provider portal.
Does Blue Care Network of Michigan work in other states?
One of the hallmarks of having your Blue Cross Blue Shield of Michigan card is being able to access care wherever and whenever you need it – anywhere across the country.