Healthy Blue Choices POS: Requirements (Including Prior Authorization)

• Providers located in Michigan follow the prior authorization requirements outlined in Michigan providers: BCN global referral, plan notification and prior authorization requirements. These requirements apply to Michigan providers whether they are contracted with BCN or not.
• Providers located outside of Michigan follow the prior authorization requirements outlined in Non-Michigan providers: BCN prior authorization requirements. These requirements apply to non-Michigan providers whether they participate with a BlueCard^® Traditional plan or not.
  
  Note: A BlueCard Traditional-participating provider is one who's contracted with their local Blue Cross Traditional plan.

Providers must follow these prior authorization requirements regardless of whether the Healthy Blue Choices member (dependent) is enrolled at a Michigan address or at an address outside of Michigan.

See the table below for some examples of which prior authorization requirements apply.

Healthy Blue Choices members enrolled with a Michigan address must select a BCN commercial primary care provider, but they still have the option to seek care from other physicians and specialists without a referral.

Healthy Blue Choices members enrolled with a non-Michigan address don't need an assigned primary care provider. They also don’t need a referral; they just need to see a BlueCard Traditional-participating provider if they want to pay the lower in-network out-of-pocket costs.