Important Legal and Privacy Information|Important Information About Medicare Plans|Privacy Practices In 2019, you can choose a primary care physician to coordinate your care from any Michigan county. A referral is permission from your primary care physician and your health plan to see a particular provider or to have specific procedures done. Blue Cross commercial only. Electronic Prior Authorization (PDF) Download. If an authorization is required, University of Michigan Health System clinic staff will obtain the authorization from your health plan prior to the service. Get access to your employer portal. Site Map|Feedback|Download Adobe Acrobat Reader, Learn more about a Healthier Michigan.org, Important Information About Medicare Plans. Michigan Health Insurance. Find a Doctor Blue Cross Preferred HMO plans View Map Our Preferred plans have higher monthly payments than our other HMO plans. For billing and insurance questions, please contact Patient Customer Services at: Below is a list of insurances that Michigan Medicine participates with based on Medical benefits. Individuals attempting unauthorized access will be prosecuted. This page provides Blue Cross Blue Shield of Michigan's prior authorization requirements, including information that applies to: Blue Cross commercial and Medicare Plus Blue. Blue Prefe rred Plus_0000_10 00_2021_2022 Customer Service: (800) 432-0750 1/2 Footnotes: The deductible must be met before benefit payments are made for services with coinsurance. Register Now, Not registered? We provide health insurance in Michigan. Click Secure Provider Resources (Blue Cross and BCN) on the Resources tab. We provide health insurance in Michigan. You can find VSP eye care professionals who accept our plans by searching vsp.com. We've provided the following resources to help you understand Anthem's prior authorization process and obtain authorization for your patients when it's required. Transportation Services For rides to medical services covered by Blue Cross Complete of Michigan, call or go online: 18888034947 TTY users call 711. mibluecrosscomplete.com/transportation Need a ride to your doctor's office, to pick up a prescription or for other medical services? Get access to your online account.Register Now, Not registered? Toll-free (855) 855-0863 or (734) 615-0863, Monday through Friday 8 a.m. 4 p.m. AHL Administrative Services Only (ASO) Self-Funded Plans HMO, AHL Administrative Services Only (ASO) Self-Funded Plans EPA, AHL Administrative Services Only (ASO) Self-Funded Plans EPO, AHL Administrative Services Only (ASO) Self-Funded Plans PPO, AHL CDHP Comprehensive Basic Full HAP EPA, AHL EPA (HFHS Advantage Tiered Access EPA Plan), BCN Virtual Primary Care (Specialty Care Only), U-M Domestic Student Health Insurance Plan, U-M International Student Health Insurance Plan, Prescription Blue Group PDP and Individual PDP, Traditional coverage (comprehensive major medical), Blue Cross Medicare Private Fee for Service, Optum Health / UnitedHealthcare - Community Care Network (CCN), Alliance Health and Life Personal Alliance PPO, HAP Jackson Health Network Select HMO Jackson County Employer Group only (Tier 1 for Pediatric Services only), HAP MA Primary Choice Referral from Primary Choice PCP needed, HAP Senior Plus Henry Ford Tiered Access Tier 2, HAP Senior Plus Option 1 and Option 2 (HMO-POS), HAP Senior Plus (PPO) (Options 1, 2, 3 and 4), Humana Commercial PPO products (through Cofinity network), McLaren Health Advantage PPO (Employees of McLaren Healthcare System), McLaren Health Advantage PPO (self-insured and fully-insured), McLaren Health Plan Community Point of Service (POS), McLaren Health Plan Healthy Michigan Plan HMO, Medicare Complete Care Select (HMO D-SNP), Paramount Preferred Options PPO (Through CuraNet/HAP AHL), Administrative Services Only ASO (Through CuraNet/HAP AHL), Parkview Signature Care PPO Exclusive Advanced, Parkview Signature Care PPO Exclusive Elite, Sparrow Health System Group Benefit Plan (PPO), University of Michigan Health Advantage Plus. These plans cover vision care for members who are age 18 and younger. You'll need to submit a prior authorization request and follow our medical policies to avoid a rejected claim. bcbsm.com Customer Service: 800-662-6667 TTY/TDD: Tolocate participating800-257-9980 providers outside of Michigan: 800-810-2583Misuse may result in prosecution.If you suspect fraud: 800-482-3787Mental health/substance abuse treatment: 800-482-5982 888-826-8152Dental Servicing: Doctors and hospitals in our Blue Cross Preferred network have to meet strict standards such as: Doctors: Board certification Acceptable malpractice claim history A state license with no disciplinary actions Hospitals: Accreditation by a nationally recognized organization Centers for Medicare & Medicaid Services certification You can submit your request by logging in to the provider portal or using Novologix. All Blue Cross Blue Shield of Michigan member ID cards have the same basic layout, but the information on each card may vary slightly, depending on the member's benefits. 1996-2023 Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association. If you don't have access to the provider portal, learn how to get an account. Some services for Medicare Plus BlueSM PPO and BCN AdvantageSM members require practitioners and facilities work with us or with one of our contracted vendors to request prior authorization before beginning treatment. These lists aren't all-inclusive. Register Now, Not registered? Get access to your online account.Register Now, Not registered? If you have questions about whether a service will be authorized, please call your health plan. You can submit your request by logging in to the provider portal or using Novologix. Register Now. 1996-2023 Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association. Prior Authorization and Step Therapy Guidelines for Preferred Drug List (PDF) Download. Need to treat a Blue Cross Medicare Plus BlueSM PPO and BCN AdvantageSM HMO-POS or BCN Advantage patient with medical drugs at a provider office, an outpatient facility location or the patients home? Individuals attempting unauthorized access will be prosecuted. If you arrive for services without a referral in place, you may be asked to sign a waiver that holds you financially responsible for the services you receive. Patient & Visitor Guide For Patients Insurance Plans Insurance Plans Michigan Medicine participates with most health insurance plans. January 1, 2022 - December 31, 2022 www.bcbsm.com/mpsers Turnip Rock Port Austin, Michigan About the medical plan When you retire, you and your eligible dependents can enroll in health care coverage through the Michigan Public School Employees' Retirement System. Not Registered? View all. Authorizations are often required for procedures such as surgery or MRI. Get access to your member portal. Blue Cross Blue Shield of Michigan and Blue Care Network members. State and Federal Privacy laws prohibit unauthorized access to Member's private information. Date posted: May 9, 2023 Additional fee change schedules added to our provider portal Blue Cross Blue Shield of Michigan recently added these additional fee change schedules to our provider portal, as of 05-12-2023: Professional Traditional, TRUST and Blue Preferred PlusSM (BPP) Injections Facility Hospital Outpatient State and Federal Privacy laws prohibit unauthorized access to Member's private information. Medicare Plus Blue PPO Vitality (PPO) H9572-002 Blue Cross Blue Shield of Michigan | Local PPO Other Plan Options Other Plan Options Ready to Buy a Medicare Plan? Michigan Medicine participates with most health insurance plans. Our Preferred plans have higher monthly payments than our other HMO plans. 24-Hour Nurse Line Talk to a registered nurse at no additional cost anytime when you have questions about an illness or injury. We provide health insurance in Michigan. Call 1-800-775-BLUE (2583). For Behavioral Health benefits, participation status may vary here at Michigan Medicine. Hemgenix (etranacogene dezaparvovec) medical policy (PDF), Syfovre (pegcetacoplan) medical policy (PDF). Get access to your agent portal. Get access to your member portal. In 2019, you can choose a primary care physician to coordinate your care from any Michigan county. See the links within the accordions for information on prior authorization requirements for specific services. We provide health insurance in Michigan. Get access to your agent portal. Register Now, Learn more about registering for our web tools. Individual and Family Plans . The nurse line can help you determine if you can treat things at home. Many insurance plans require referrals and/or authorizations in order for services to be covered. Individuals attempting unauthorized access will be prosecuted. We recommend that you check with your insurance company to confirm benefit coverage prior to scheduling an appointment. But they also give you the most access to Michigan's largest HMO network. ACA Marketplace plans for individuals, families and small businesses. You can submit a prior authorization request through logging in to the provider portal or by faxing in theglobal request form (PDF). We recommend that you check with your insurance company to confirm benefit coverage prior to scheduling an appointment. Register Now, Not registered? Site Map|Feedback|Download Adobe Acrobat Reader, Learn more about a Healthier Michigan.org, How We Choose Providers for Our HMO Networks, Important Information About Medicare Plans, A state license with no disciplinary actions, Accreditation by a nationally recognized organization, Centers for Medicare & Medicaid Services certification, Oversight by a state-licensed medical director without disciplinary actions. Not registered? Get access to your online account. You'll need to submit a prior authorization request and follow our medical policies to avoid a rejected claim. For Behavioral Health benefits, please contact your plan directly, as they may have chosen to use a different company to administer these benefits which we may not accept. Register Now, Not registered? See the links within the accordions for information on prior authorization requirements for specific services. Get access to your employer portal.Register Now, Learn more about registering for our web tools.Register Now, Not registered? TTY users should call 711. Not Registered? Prior authorization requirements. Register Now, Learn more about registering for our web tools. Some unique selffunded products have their own names, such as Blue Preferred Plus, a PPO product for auto groups in a 21county network, GeoBlue . Register Now. State and Federal Privacy laws prohibit unauthorized access to Member's private information. We provide health insurance in Michigan. Get access to your agent portal.Register Now. Important Legal and Privacy Information | Important Information About MedicarePlans | Privacy Practices | Site Map | Feedback | Download Adobe Acrobat Reader, You can find which drugs need prior authorization by viewing our, If you don't have access to the provider portal, learn how to, Medicare Advantage Medical Drug Prior Authorization and Step Therapy List (PDF), Aduhelm (aducanumab-avwa) medical policy (PDF), Alpha-1 proteinase inhibitors medical policy (PDF), Botulinum toxin type A medical policy (PDF), Botulinum toxin type B medical policy (PDF), Calcitonin Gene Related Peptide Antagonists medical policy (PDF), Carvykti (ciltacabtagene autoleucel) medical policy (PDF), Colony stimulating factors medical policy (PDF), Duchenne Muscular Dystrophy medical policy (PDF), Enjaymo (sutimlimab) intravenous injection medical policy (PDF), Enzyme Replacement Therapy for Fabry Disease medical policy (PDF), Enzyme replacement therapy for Gaucher's Disease medical policy (PDF), Enzyme replacement therapy for Mucopolysaccharidosis medical policy (PDF), Enzyme Replacement Therapy for Pompe Disease medical policy (PDF), Hyaluronic acid intra-articular injections medical policy (PDF), Immune globulin replacement therapy medical policy (PDF), Intravenous Iron Replacement medical policy (PDF), (voretigene neparvovec-rzyl) medical policy (PDF), Pulmonary arterial hypertension medical policy (PDF), Vyjuvek (beremagene geperpavec) medical policy (PDF), Xenpozyme (olipudase alfa-rpcp) medical policy (PDF), Important Information About MedicarePlans. Individuals attempting unauthorized access will be prosecuted. In the meantime, you can submit your prior authorization request by locating the appropriate form on this page and faxing it. Register Now, Not registered? State and Federal Privacy laws prohibit unauthorized access to Member's private information. 1996-document.write(new Date().getFullYear()); Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association. Shop Plan Now 2023 Overall. A Blue Cross . Get access to your employer portal.Register Now, Learn more about registering for our web tools.Register Now, Not registered? Register Now, Not registered? View our medical policies to learn about our drug guidelines. Get access to your online account. Health insurance can be complicatedespecially when it comes to prior authorization (also referred to as pre-approval, pre-authorization and pre-certification). Doctors and hospitals in our Blue Cross Preferred network have to meet strict standards such as: 1996-document.write(new Date().getFullYear()); Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association. If you don't have access to the provider portal, learn how to get an account. Get access to your agent portal.Register Now. Just ask your local pharmacy. You can learn more by clicking the relevant link in the Blue Cross or BCN section on ourereferrals.bcbsm.com website. Get access to your employer portal. Some services for Medicare Plus Blue SM PPO and BCN Advantage SM members require practitioners and facilities work with us or with one of our contracted vendors to request prior authorization before beginning treatment.. But they also give you the most access to Michigan's largest HMO network. Not registered? Blue Preferred PlusSM 0020 $2,500 Deductible Plan Highlights copayments, deductible, out-of-pocket limits, member coinsurance percentage amounts, and provides a brief description of Blue Preferred Plus Health Care Plan benefits. Urgent care centers If you have questions related to estimates for out-of-pocket costs, please visit our Estimates for Out-of-Pocket Costs page. If your plan requires a referral, your primary care physician must provide the referral prior to services being rendered. Important Legal and Privacy Information | Important Information About MedicarePlans | Privacy Practices | Site Map | Feedback | Download Adobe Acrobat Reader, Summary of Utilization Management Programs for Michigan Providers (PDF), BCBSM and Blue Care Network Prior Authorization/Step Therapy Guidelines (PDF), Post-acute care (SNF, inpatient rehab, LTAC), Behavioral health (mental health and substance use disorders), Drugs covered under the medical benefit (including medical oncology), Musculoskeletal surgical and other related procedures (orthopedic, pain management and spinal), Cardiology procedures managed by Carelon (formerly known as AIM), Physical, occupational and speech therapy (non-autism), Non-Michigan providers: BCN referral and authorization requirements (PDF), Important Information About MedicarePlans. 1996-2023 Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross . Your physician can refer you to over 16,500 specialists and 141 hospitals. Click Coronavirus on the Member Care tab. For Behavioral Health benefits, participation status may vary here at Michigan Medicine. In the meantime, you can submit your prior authorization request by . Non-Michigan providers who treatMedicare Advantage members who travel or live outside of Michigan should review the following documents: 1996-2023 Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association. With 98 percent of Michigan pharmacies in our network, it's easy to find one that accepts these plans. Blue Care NetworkAdvantage (BCN) Medicare, Blue Cross Blue Shield Federal Employee Program, Blue Cross Blue Shield of Michigan(BCBSM), Blue Cross Blue Shield of Michigan(BCBSM) Medicare, Health Alliance Plan (HAP) Medicare Plans, PHP of Northern Indiana HMO/PPO (specialty services only), Private Health Care Systems (PHCS)/Multiplan, UnitedHealthcare Community Plan(Michigan Only), Report Sexual Misconduct, Discrimination and Harassment, Copyright 1995-2022 Regents of the University of Michigan. Important Legal and Privacy Information|Important Information About Medicare Plans|Privacy Practices We recommend that you always check with your insurance plan before scheduling these type of services. A "PPP" is a Primary Preferred Provider in the Blue Preferred an d PPO Provider networks.
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