Skilled nursing, inpatient rehabilitation and long-term acute care for Michigan providersĮffective June 1, 2016, send precertification requests for skilled nursing, long-term acute care and inpatient rehab facilities for Michigan residents and members to eviCore Healthcare.Ĭall 1-87. To make sure that the member is receiving the most appropriate care in the most appropriate setting, the following facilities are required to precertify services before admitting a Medicare Plus Blue PPO member: Preauthorizationįor continuity of care, Michigan hospitals, including Michigan hospitals with swing beds, are required to submit a preauthorization request through e-referral when admitting a Medicare Plus Blue SM PPO member. We strongly recommend that you use InterQual ® clinical criteria for preauthorization of hospital admissions to determine the medical necessity of hospital admissions before you call for authorization. Clinical necessity and criteria help identify cases that may benefit from the assistance of one of our preauthorization programs.
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.
