Referrals & Authorizations: BCN Prior Authorization & Plan Notification
Blue Care Network requires prior authorization for certain procedures to ensure that members get the right care at the right time and in the right location.
For BCN commercial members only, we require plan notification for certain services. Plan notification alerts BCN to a scheduled service and facilitates claims payment (clinical review isn't needed). Providers must follow the requirements that apply to the region in which their medical care group's headquarters is located:
- In the East and Southeast regions, providers must submit plan notification to BCN through the e-referral system.
- In the Mid, West and Upper Peninsula regions, plan notification isn't required so providers don't need to submit anything in the e-referral system.
Health care providers must submit both prior authorization requests and plan notifications before providing services. For more information, see the following documents:
- Michigan providers: BCN global referral, plan notification and prior authorization requirements
— Visit the "Plan notifications" and "Prior authorizations" sections. - e-referral User Guide
Prior authorization information
- Summary of utilization management programs for Michigan providers
- Procedure codes for which providers must request prior authorization
- Michigan providers: BCN global referral, plan notification and prior authorization requirements
- Prior authorization requirements for Michigan and non-Michigan providers for Blue Cross commercial and Medicare Plus Blue℠
- How to access the criteria used for prior authorizations made by Blue Cross or BCN (for non-behavioral health cases)
- Peer-to-peer reviews:
- 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)
- Pediatric Choice:
- Routine Women's Health Benefit (formerly known as Woman's Choice):
For Blue Cross Commercial Members only
- Federal Employee Program® Consent for Case Management
- Prior authorization requirements for MESSA members
For Medicare Plus Blue PPO Members only
Note: For utilization management information for Blue Cross Complete, go to MiBlueCrossComplete.com/providers.
Preview questionnaires and medical necessity criteria for select services
We use pertinent medical necessity criteria to make determinations on prior authorization requests for select services. To determine which services have questionnaires and to view preview questionnaires and medical necessity criteria, see Preview questionnaires and medical necessity criteria.
Utilization management forms
You can find links to forms related to utilization management under the corresponding service page on this website and on our Provider Resources site, by logging in to our Provider Portal.
Questions? Get help accessing our Provider Portal.
Documents and forms for noncontracted or non-Michigan providers
- Non-Michigan providers: BCN prior authorization requirements
- Prior authorization requirements for Michigan and non-Michigan providers for Blue Cross commercial and Medicare Plus Blue
- For Providers: What if I Don’t Participate with Medicare? on bcbsm.com. This page provides access to the Waiver of Liability Statement, along with other pertinent documents and forms
Frequently accessed documents
Additional resources
©2025 – Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association.