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.
Does PPO require prior authorization?
PPOs differ on which tests, procedures, services, and treatments they require pre-authorization for, but you should suspect you’ll need pre-authorization for anything expensive or anything that can be accomplished more cheaply in a different manner.
Who is responsible for obtaining precertification?
If your health care provider is in-network, they will start the prior authorization process. If you don’t use a health care provider in your plan’s network, then you are responsible for obtaining the prior authorization.
Is Medicare Plus Blue PPO available in every county in Michigan?
Medicare Plus BlueSM network All of our PPO network plans are available to residents who live in any Michigan county at least six months of the year.
Does BCBS of Michigan Cover 3D mammograms?
Beginning with June 6, 2017, dates of service for individual, small group and large group health plans, 3D mammography for screening purposes will be covered at 100 percent, with no member cost share (copayments, deductibles or coinsurance).
Is NIPT covered by Blue Cross Blue Shield Michigan?
We recommend that you visit your doctor as soon as you suspect you’re pregnant….Prenatal exam schedule.
| Pregnancy Stage | How often |
|---|---|
| First prenatal visit | When you first suspect you’re pregnant |
| Weeks 14 – 30 | Every four weeks |
| Weeks 30 – 36 | Every two weeks |
| Weeks 36 – 40 | Every week |
What is the difference between predetermination and precertification?
The main difference between a predetermination and a preauthorization is that the predetermination provides a confirmation that the patient is a covered enrollee of the dental plan and that the treatment planned for the patient is a covered benefit.
What’s the difference between precertification and prior authorization?
Sometimes called prior authorization, prior approval or precertification. Your health insurance or plan may require preauthorization for certain services before you receive them, except in an emergency. Preauthorization isn’t a promise your health insurance or plan will cover the cost.
How much is Medicare Plus Blue?
| Blue Shield Rx Plus (PDP) | Blue Shield Rx Enhanced (PDP) | |
|---|---|---|
| Monthly plan premium | $90.20 | $160.20 |
| Annual deductible | $4802 | $0 |
| Formulary | Basic | Enhanced* |
| Network pharmacies with preferred cost-sharing | Albertsons/Osco/Sav-on, Costco, CVS Pharmacy (including CVS pharmacy at Target), Safeway, Vons, Walmart and Ralphs |
What is a Medicare Plus plan?
The Medicare Plus Card offers discounts on prescription drugs, dental, vision and hearing care. If you have a Medicare Advantage plan that includes some of these benefits, you may not need to consider getting the Medicare Plus Card.
How does Blue Cross Blue Shield of Michigan preauthorization work?
Blue Cross Blue Shield of Michigan uses the following precertification, and preauthorization programs to ensure that our network doctors and hospitals provide the most appropriate and cost-effective care. Clinical necessity and criteria help identify cases that may benefit from the assistance of one of our preauthorization programs.
What is the Medicare plus blue prior authorization codes list (PDF)?
The Medicare Plus Blue prior authorization codes list (PDF) represents procedures that require authorization by eviCore healthcare for Medicare Plus Blue PPO members who reside in Michigan and receive services from Michigan providers. Providers must obtain authorization from eviCore before these services are provided.
Is Blue Cross Blue Shield of Michigan a nonprofit organization?
©1996– Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association. State and Federal Privacy laws prohibit unauthorized access to Member’s private information.
Do you have to submit a predetermination for a request?
Instructions for Submitting REQUESTS FOR PREDETERMINATIONS. Predeterminations typically are not required. A predetermination is a voluntary, written request by a provider to determine if a proposed treatment or service is covered under a patient’s health benefit plan. Predetermination approvals and denials are usually based on our medical policies.