Sleep Studies

Resources

Sleep studies have the following utilization management requirements:

Setting	Details	Submit requests through
Home	For Blue Care Network commercial members in the East and Southeast regions, submit plan notification to BCN to facilitate claims payment (clinical review isn't needed). See the BCN Prior Authorization & Plan Notification page for additional information. Important: Only providers who have signed a specific sleep testing agreement may provide sleep management services to BCN members.	e-referral system
In lab — includes the implantation of hypoglossal nerve stimulation devices	For Blue Cross Blue Shield of Michigan commercial members who have coverage through Chrysler, Delphi / Aptiv, General Motors or UAW Retiree Medical Benefits Trust. The requirements outlined above don't apply to the UAW Retiree Health Care Trust (group number 70605) or the UAW International Union (group number 71714).	For dates of service on or after Nov. 3, 2025: Carelon Medical Benefits Management — for adult members only (ages 18 and older) For dates of service before Nov. 3, 2025: Carelon — for both adult and pediatric members
For Blue Cross commercial members: All fully insured groups, including MESSA Self-funded groups other than those noted above All members with individual coverage Members who have coverage through the Blue Cross and Blue Shield Federal Employee Program^®, the State of Michigan and select Ascension Health groups don't require prior authorization for in-lab sleep studies.	For dates of service on or after Nov. 3, 2025: e-referral system — for adult members only For dates of service before Nov. 3, 2025: Carelon — for both adult and pediatric members
For BCN commercial members: For adult members, submit prior authorization requests. For pediatric members (17 or younger) when the in-lab sleep study will be performed in the East or Southeast region, submit plan notification. See the BCN Prior Authorization & Plan Notification page for more information. Important: Only providers who have signed a specific sleep testing agreement may provide sleep management services to BCN members.	For dates of service on or after Nov. 3, 2025: e-referral system For dates of service before Nov. 3, 2025: Carelon — Submit prior authorization requests for both adult and pediatric members

Setting

Details

Submit requests through

Home

For Blue Care Network commercial members in the East and Southeast regions, submit plan notification to BCN to facilitate claims payment (clinical review isn't needed).

See the BCN Prior Authorization & Plan Notification page for additional information.

Important: Only providers who have signed a specific sleep testing agreement may provide sleep management services to BCN members.

e-referral system

In lab — includes the implantation of hypoglossal nerve stimulation devices

For Blue Cross Blue Shield of Michigan commercial members who have coverage through Chrysler, Delphi / Aptiv, General Motors or UAW Retiree Medical Benefits Trust.

The requirements outlined above don't apply to the UAW Retiree Health Care Trust (group number 70605) or the UAW International Union (group number 71714).

For dates of service on or after Nov. 3, 2025: Carelon Medical Benefits Management — for adult members only (ages 18 and older)

For dates of service before Nov. 3, 2025: Carelon — for both adult and pediatric members

For Blue Cross commercial members:

All fully insured groups, including MESSA
Self-funded groups other than those noted above
All members with individual coverage

Members who have coverage through the Blue Cross and Blue Shield Federal Employee Program^®, the State of Michigan and select Ascension Health groups don't require prior authorization for in-lab sleep studies.

For dates of service on or after Nov. 3, 2025: e-referral system — for adult members only

For dates of service before Nov. 3, 2025: Carelon — for both adult and pediatric members

For BCN commercial members:

For adult members, submit prior authorization requests.
For pediatric members (17 or younger) when the in-lab sleep study will be performed in the East or Southeast region, submit plan notification. See the BCN Prior Authorization & Plan Notification page for more information.

Important: Only providers who have signed a specific sleep testing agreement may provide sleep management services to BCN members.

For dates of service on or after Nov. 3, 2025: e-referral system

For dates of service before Nov. 3, 2025: Carelon — Submit prior authorization requests for both adult and pediatric members

How to submit prior authorization requests

To learn how to submit requests, see our Getting Started page.

Submit requests before providing services.

Utilization Management Criteria

Visit our Utilization Management Criteria page.

Carelon Medical Benefits Management is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to manage prior authorizations for select services.