Revised March 2021 . Find out about new programs, advice on choosing a primary care physician and detailed information on your plan. All responses to our surveys are aggregated to create summarized results (such as gender, age or other demographic information). Modifications of InterQual criteria starting Aug. 1, 2022. We are not obligated to notify you of changes to the Terms. If you are eligible, you may want to consider enrolling in a pre-taxhealth care Flexible Spending Account (FSA)to complement your health plan. Provider Providers in Blue Care Network P.O. WebProvider; Agent; Not Registered? View your claims history. You will be prompted to change your password at regular intervals. Medical Policy Router Search. But some providers dont submit claims to us. You'll pay less when you see a dentist in our PPO network. Our Blue Care Network HMO plans are an affordable solution for cost-conscious buyers. Carelon-Managed Procedures (formerly AIM), Behavioral Health Continuing Outpatient Treatment Request Form, Entering behavioral health provider names and NPIs, Mental health disorders: partial hospital program, Residential mental health treatment (adult/geriatric and child/adolescent), Mental health disorders: partial hospital program and intensive outpatient program, Substance use disorders: partial hospital program and intensive outpatient program, Neurofeedback for attention deficit disorder / attention deficit hyperactivity disorder, Documentation requirements for applied behavior analysis services, Documentation requirements and privacy regulations for services other than ABA, Behavioral health resources to discuss with your patients, Submitting authorization requests through e-referral - FAQ, Holiday closures: How to submit authorization requests for inpatient admissions, Instructions for filling out CMS-1500 form (02/12), Requirements for providing behavioral health services to BCN members, LLPs and LMFTs Frequently asked questions, HEDIS tip sheet for antidepressant medical management, Administering long-acting injectable medications at home (behavioral health), Requirements for drugs covered under the medical benefit - BCN HMO and Blue Cross PPO, Outpatient detoxification and follow-up care protocols for treating substance use disorders, Behavioral health: For mental health and substance use disorders, general assistance with behavioral health services, For local rules on autism spectrum disorder / applied behavior analysis, see the, Discuss or receive information on criteria used to render an authorization decision. InterQual. Ryan Krochak, M.D, is a fellowship-trained sports medicine physician. 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. For information about drugs covered under the medical benefit, visit the Medical Benefit Drugs Pharmacy page on this website. Anyone seeking or accepting any of the benefits provided will be deemed to have accepted the terms of the benefits programs and the university's right to modify, amend, or terminate them. We and our content providers retain all right, title and interest in the content that (1) We make available to you, and (2) that is submitted, posted, or otherwise shared by you or anyone else on the App. WebOur Blue Cross Partnered network has primary care physicians, specialists and hospitals in West Michigan that are part of Mercy Health System. The best way to reach us by phone is to call the Customer Service number on the back of your Blue Cross ID card or on your Explanation of Apple and the Apple logo are trademarks of Apple Inc., registered in the U.S. and other countries. Not registered? For complete information on benefits and coverage, please refer to the plan documents. WebYou can find a Blue Cross Complete doctor or pharmacy using our online search. Search BCBSM in the App Storeor Google Play Store or text 222764. Call us if you have questions about getting approval for treatment or a procedure. Then, confirm your selection. All rights reserved. Our members love it, and we think you will, too. Services received outside of Network 1 or Network 2 are not covered, except in the event of emergency (refer to plan documents for details). WebBlue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross Blue Shield Association. Deductibles, co-insurance and prior-authorization requirements apply in some circumstances. Note: For BCN Advantage members admitted to post-acute care, see Post-acute care services: Frequently asked questions by providers (PDF). We may amend these Terms at any time by posting a revised version on the App or on our website. We provide these links as a courtesy to help you find information. 4.60. Southfield, MI 48076. Providers If you have any questions about our online privacy practices, call 313-225-9000. Dr. Bhusri is the leading Heart Specialist on the Upper East Side of Manhattan. Dr. Jones graduated with honors from Smith College and completed her medical school training at Cornell University Medical College. Just tap the app. To get copies of individual rights forms, please visit ourProtected Health Information and Privacy Forms page. Everyday Health is among the federally registered trademarks of Everyday Health, Inc. and may not be used by third parties without explicit permission. Your mobile app gives you up-to-date detailsabout your claims status, deductible balances and more. WebFor Providers: Drug Lists. For example, when you provide us personal information (like your name, email address or telephone number) to set up, log into or use your BCBSM account. We provide health insurance in Michigan. YOU REPRESENT AND WARRANT THAT THE INFORMATION YOU SUBMIT VIA THE APP IS TRUE AND ACCURATE AND THAT YOU ARE SOLELY RESPONSIBLE FOR ANY DAMAGES OR LOSSES ASSOCIATED WITH THE SUBMISSION OF FALSE OR MISLEADING INFORMATION. Quick Tip. Your health insurance plan pays the rest of the cost. If you are dissatisfied with any of the material on the App, or with any of BCBSM's Terms, your sole and exclusive remedy is to discontinue using the app. They coordinate all your care and can refer you to trusted doctors and specialists in your network. Below are links to documents detailing Blue Care Network's authorization and referral requirements for services managed by BCN, including lists of procedures that require authorization and authorization criteria and preview questionnaires for various procedures. State and Federal Privacy laws prohibit unauthorized access to Member's private information. Show me where. When you register to use this password-protected App, you will establish your account password. This plan type helps pay for prescription drugs. They're only available through private health insurance companies, like Blue Cross. WebTo reach a customer service representative, please call the number listed on the back of your enrollee ID card. Their primary care physician can then refer them to more than 25,000 specialists around the state. Register Now, Learn more about registering for our web tools. WebThis brochure describes the benefits of Blue Care Network of Michigan (BCN) under contract (CS 2011) between Blue Care Network of Michigan and the United States Office of Personnel Management, as authorized by the Federal Employees Health Benefits law. It's a good idea to call the pharmacy first to make sure they're still in our network. Find the ideal option for you. Medical Policy & Pre-Cert/Pre-Auth Router. With it, you can update your information with us and enroll new practitioners within your group. In compliance with the Children's Online Privacy Protection Act of 1998 (COPPA), we do not knowingly solicit data from children younger than 18 years of age and we do not knowingly market to children younger than 18 years of age. This form can be used for the following: 1. Provider YOU ARE FULLY RESPONSIBLE FOR ALL LOSSES, DAMAGES OR CONSEQUENCES RESULTING FROM ANY ACTIVITY ON THE APP OR ON BCBSM.COM PERFORMED USING YOUR ACCOUNT. Authorization criteria and preview questionnaires. Important Legal and Privacy Information|Important Information About MedicarePlans|Privacy Practices|Site Map|Feedback|Download Adobe Acrobat Reader, Y0074_BCBSMBCNWeb_M_2023_C CMS Accepted 04232023, Page Last Updated Tue Jul 18 20:07:55 EDT 2023. Our privacy policy tells you how we can and cannot use your information. WebBlue Care Network of Michigan is a nonprofit health maintenance organization. While we may inform you when you are leaving the App and going to either a third party website or a website operated by one of our vendors, we are not required to do so. Members: Pay Your Bill | BCBSM Important information about Medicare supplement plans. WebFor medical advice, or to receive medical diagnosis or treatment, consult with your health care provider. WebIf you're a Blue Care Network member, we've provided you with a list of resources to help you learn more about your health care coverage. WebPage i BCN Provider Manual (BCN commercial and BCN Advantage) Revised June 27, 2023 . and in . If your employee has a Michigan address, theyll need to select a primary care provider, or PCP. Deductibles, co-insurance and prior-authorization requirements BCN network Blue Care Network provides materials and resources to assist you with your behavioral health referrals. WebYour care choice. Changes are made to the App often and can occur at any time and without notice. Providers in the Value Network have agreed to offer standard hearing aid options that will not result in out-of-pocket costs. Although the university has elected to provide these benefits this year, no individual has a vested right to any of the benefits provided. Coverage for hearing services has not changed. WebLearn more about a Healthier Michigan.org A Healthier Michigan Search 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. HMO stands for health maintenance organization. You dont need a primary care physician. WebThe best way to get the most current list of doctors is on bcbsm.com. Blue Care Network HMO: 1-800-482-5982. You'll also find lists of claims that can't be processed electronically and a library with helpful documents. Carelon-Managed Procedures (formerly AIM), Summary of utilization management programs for Michigan providers, Procedure codes for which Michigan and non-Michigan providers must request prior authorization, BCN referral and authorization requirements for Michigan providers, About Blue Dot Changes to the BCN referral and authorization requirements document for Michigan providers, BCN-managed procedure codes that require authorization for Michigan providers, Non-Michigan providers: Referral and authorization requirements for BCN members, Submitting acute inpatient authorization requests: Frequently asked questions for providers, Medicare Advantage inpatient assessment form, Inpatient medical admissions, acute care (hospitals): For authorization determinations, Post-acute care admissions: Submitting authorization requests, Post-acute care services: Frequently asked questions by providers, Post-acute care: For skilled nursing, rehabilitation and long-term acute care facilities, Holiday closures: How to submit authorization requests for inpatient admissions, Non-emergency air ambulance prior authorization program: Overview for MI and non-MI providers, Air ambulance flight information (non-emergency) form, 2022 Blue Cross and BCN Local Rules for acute inpatient medical admissions of adults care, Local Rules for acute inpatient medical admissions of adults: Frequently asked questions, 2023 Blue Cross and BCN Local Rules for post-acute care, 2022 Blue Cross and BCN Local Rules for post-acute care, How to request a peer-to-peer review with a Blue Cross or BCN medical director, Physician peer-to-peer-request form (for non-behavioral health cases), Cardiology: For home monitoring and cardiology and echocardiology procedures, Chiropractic services: For chiropractic manipulations and physical medicine services by chiropractors, Cosmetic procedures: For authorization determinations, Diabetes: For coaching, management, behavioral counseling and supplies, Durable medical equipment and prosthetics and orthotics: For authorization determinations, Elective procedures and services: For authorization determinations, Laboratory: For genetic testing and molecular testing, Surgeries: For decision support and authorization determinations, Transplants: For authorization determinations, Woman's Choice Referral and Authorization Guidelines, Woman's Choice specialty and procedure/diagnosis code requirements, Dental anesthesia or immediate repair of trauma to natural teeth, Endoscopy, upper gastrointestinal, for gastroesophageal reflux disease, Endovascular intervention, peripheral artery, Endovenous ablation for treatment of varicose veins, Experimental and investigational services, Facial and neck hair removal (for University of Michigan employees only), Facial feminization surgery and chondrolaryngoplasty (for University of Michigan employees only), Medical formula for inborn errors of metabolism, Radiofrequency ablation (RFA), cardiac, trigger, Radiofrequency ablation (RFA), cardiac atrial fibrillation or atrial flutter, Radiofrequency ablation (RFA), cardiac frequent monomorphic premature ventricular contractions, Radiofrequency ablation (RFA), cardiac nonsustained ventricular tachycardia, Radiofrequency ablation (RFA), cardiac suspected AVNRT, AVRT or focal atrial tachycardia, Radiofrequency ablation (RFA), cardiac sustained (more than 30 seconds) ventricular tachycardia, Radiofrequency ablation (RFA), cardiac treatment for preexcitation syndrome or WPW syndrome, Responsive neurostimulator/deep brain stimulation trigger, Responsive neurostimulation for the treatment of refractory partial epilepsy, Sleep studies, outpatient facility and clinic-based, Vascular embolization or occlusion of hepatic tumors (TACE/RFA), Out-of-network providers For prior authorization requests for procedures to be completed by providers who arent contracted with BCN. Log in now. Individuals attempting unauthorized access will be prosecuted. Transitioning to the Availity provider Enter your ZIP code to see customized plans and prices for your area. Get access to your online account. Dr. Joseph Schwartz, MD is an endocrinology, diabetes & metabolism specialist in Englewood, NJ and has been practicing for many years. Get access to your online account. We provide health Tap "Select PCP" underneath the primary care physician you'd like to choose. WebThat means we have the most doctors, hospitals and providers who accept our plans. (For example: If you register two or more providers, you must send a fax/email for each provider. Select "Get Started." Any such links are provided as a courtesy to help you find information. Blue TTY users dial711. It allows more than 170,000 monthly users to securely view deductibles, check claims, select a primary care physician and more. These acronyms all signify different health plan types: When you have an HMO plan, you choose a primary care physician who works as your partner. The App, or our website, BCBSM.com, allow you to change your password. Downloading the app is easy,search BCBSM in the App Store, or Google Play Store,or text 222764. The survey completion period has ended. Providers Individuals attempting unauthorized access will be prosecuted. Customer service may be reached at 800-662-6667 or through our website: www.bcbsm. BCN Care Management Forms - Blue Cross Blue Shield of Michigan You can also mail the completed forms and documentation to: Blue Cross Complete of Michigan, Provider Network Management, 4000 Town Center; Suite 1300, Southfield, MI 48075 6. Once there, click the green Find a Doctor button. WebWith a Blue Dental PPO plan: You can see any licensed dentist and your plan will share the cost. If you want low monthly premiums and copays and you dont travel much, an HMO plan might be right for you. EDI, or electronic data interchange, is a way to exchange information with us electronically. Blue Care Network Physician Selection Forms. You qualify if any of these apply: You're 65 or older. Thank you to those who To protect your privacy, you alone are responsible to keep your password a secret. Michigan Daytime sleepiness can be determined by using a common assessment tool not open Wi-Fi networks) and when using the App others are not in close proximity to you and cannot observe the information you input or the content displayed through the App. You shall be fully responsible for any losses or damages which arise from your noncompliance with the confidentiality obligations contained in the Terms. The App may contain inaccuracies or typographical errors. She graduated from Norman Bethune University of Medical Sciences in 1997. Click the Resources tab. This includes, but is not limited to, ensuring your mobile device is locked so others cannot access your information (including your log in information), you log out of the App when it is not in use, you access the internet through secure Wi-Fi access points (i.e. BCN Behavioral Health uses modified InterQual criteria for decisions about the following services: Modifications of InterQual criteria starting Aug. 2, 2021, through July 31, 2022. In addition to the information listed on this page, you can access the complete version of the BCN Provider Manual and other behavioral health resources including the BCN Behavioral Health Fee Schedule on the Behavioral Health page of the Member Care tab on the Provider Resources site. Click Secure Provider Resources (Blue Cross and BCN). Blue Care Network providers listed on Doctor.com have been practicing for an average of: 24.1 year (s) Average ProfilePoints score for Providers who take Blue Care Network: 68/80. Our experienced advisors and agents can help find the right Blue Cross plan for you. 24-Hour Nurse Line. Medicare Plus Blue PPO: 1-888-803-4960. BCBSM DOES NOT WARRANT THAT THE APP WILL OPERATE ERROR-FREE, OR WITHOUT INTERRUPTION OR THAT THE APP AND ITS SERVER ARE FREE OF ALL VIRUSES OR CODE HARMFUL TO YOUR EQUIPMENT, YOUR PROGRAMS OR YOU DATA. WebA preferred provider organization is a group of health care professionals who provide services at discounted rates to plan members. Home [m.bcbsm.com] BCN Provider News. You may not be able to receive services, such as home health care, home infusion, home hospice and medical equipment deliveries, in your home if you live outside Michigan. You'll see how streamlined and simple it is to use. Members must live in the state of Michigan or within Fulton, Lucas, Williams or Woods counties in Ohio. Jacqueline W. Muller, MD is a board certified ophthalmologist specializing in refractive surgery for over 24 years. It's the smart and intuitive way to understandwhat your health plan has to offer. Behavioral and mental health resources. Dr. Baum is a concerned and caring family physician serving the community of South Plainfield, NJ. Log in or register for your online account now to get easy access to your benefits and balances. Box 68710 Grand Rapids, MI 49516-8710 Providers outside Michigan, file claims with your local BCBS plan. Nothing in these materials gives any individual the right to continued benefits beyond the time the university modifies, amends, or terminates the benefit. We won't use your protected health information for marketing communications except where the law permits. You'll enjoy exclusive member discounts availablethrough Blue365, the program that saves youmoney wherever you are, nationwide. We periodically conduct two types of surveys on our corporate website or through the App. Dermatologist, Procedural Dermatology Specialist. 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. Device information: We may collect device-specific information (such as your hardware model, operating system version, unique device identifiers and mobile network information including phone number). In addition to the information listed on this page, you can access the complete version of the BCN Provider Manual and other behavioral health resources including the BCN Behavioral Health Fee Schedule on the Behavioral Health page of the Member Care tab on the Provider Resources site. Within your app, you have access to 30-minute seminarson health and well-being topics, such as mental health,age-appropriate activity and much more. Find Doctors Who Accept Blue Care Network of Michigan When you reach a certain amount, we pay for most covered services. John J Hong, MD, is a board-certified gastroenterologist who specializes in obesity management. If you are a Michigan provider, you can access the Provider Resources site through the Resources tab of our payer space on our provider portal. primary care physician online Premier Care BCN AdvantageSM. Login | Register | My online account | bcbsm.com We pay the Original Medicare deductibles for you. Every effort has been made to ensure the accuracy of the benefits information in this site. Web47. Important Legal and Privacy Information | Important Information About MedicarePlans | Privacy Practices | Site Map | Feedback | Download Adobe Acrobat Reader, Transitioning to Availity for EDI Clearinghouse HIPAA Transactions: Frequently asked questions for providers (PDF), For Providers: EDI Professional Commercial Payer Listing (PDF), ANSI ASC X12N 835 (005010X221A1) Health Care Claim Payment/Advice Companion Document (PDF), ANSI ASC X12N 837 (005010X223A2) Institutional Health Care Claim Companion Document (PDF), ANSI ASC X12N 837 (005010X222A1) Professional Health Care Claim Companion Document (PDF), ANSI ASC X12N 837 (005010X224A2) Dental Health Care Claim Companion Document (PDF), BCBSM Managed File Transfer Platform - Edifecs (PDF), ANSI ASC X12N 834 (005010X220A1) Benefit Enrollment and Maintenance Companion Document (PDF), EDI Enrollment for BlueExchange Medicare Crossover 835s (PDF), Trading Partner Agreement and Authorization: Online claim submission (portal) Frequently asked questions(PDF), Complete or Update a Provider Authorization, ASC X12N 276/277 (005010X212) Health Care Claim Status Request and Response Companion Document (PDF), ASC X12N 278 (005010X217) Health Care Services Review and Response Companion Document (PDF), ASC X12N 270/271 (005010X279A1) Health Care Eligibility Benefit Inquiry and Response (PDF), EDI Real Time SOAP/HTTPS Services: Trading Partner Guide (ANSI 270/271, ANSI 276/277) (PDF), Real Time Provider Registration Process (PDF), Important Information About MedicarePlans, Call the EDI Help Desk at 1-800-542-0945 or. Our plan options offer you the flexibility to choose how much coverage you'd like and whether you need prescription coverage as well. WebBlue Cross Blue Shield of Michigan and Blue Care Network offer care management programs Michigan providers: BCN referral and authorization requirements PDF You can view these documents and our medical policies through the . Value Network providers include Michigan Medicine Audiology Services and TruHearing providers. Members save money in Network 1, which includes Provider Enrollment and Change Self-Service is a safe, secure electronic online application within Blue Cross Blue Shield of Michigans Provider Secured Services portal that makes it easier for groups to keep their information up to date for both BCBSM and Blue Care Network. Click Coronavirus on the Member Care tab. WebSubmit Form Reset Form *By providing your phone number and/or email, you give permission for Blue Cross Blue Shield of Michigan and Blue Care Network to contact you about this communication, answer your questions, and discuss your options.By providing your email address, you give permission for Blue Cross Blue Shield of WebLog in to our provider portal ( availity.com *). Our online pharmacy directory is updated more often than our printed directories, so it's the best way to see if a pharmacy is in your plan's network. Participation in our surveys is voluntary. The plan provides coverage for dependents who reside outside the network service area and meet eligibility guidelines. In line with Woman's Choice guidelines, an obstetrician-gynecologist may perform or order some services without a referral from the primary care physician. There you will For private inquiries including those containing Protected Health Information,contact customer service. Anyone who uses the App consents to such monitoring and agrees that BCBSM may use the results of such monitoring without limitation. Board-certified in both internal medicine and rheumatology by the American Board of Internal Medicine Dr. Soloway has been recertified two times each. When you have a Blue Cross plan, we track all the costs you pay deductible, copays and coinsurance. Blue Care Network Advantage HMO: 1-800-431-1059. Policies and Practices Medicare Advantage HMO: 1-800-450-3680. 24-Hour Nurse Line. Health Plans. Modifications of InterQual criteria starting Aug. 1, 2022. BCN Behavioral Health uses its own utilization management criteria (local rules) for decisions about the following services: Medical record documentation requirements. portal WebFor these situations call 1-800-392-2512. Providers Click Secure Provider Resources (Blue Cross and BCN). 5. If you have an Availity account, go to the quick guide for Availity Essentials Success for Blue Cross Blue Shield of Michigan and Blue Care Network Providers to view the top five Blue Cross and BCN questions, and more.
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