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Acute inpatient hospital assessment form (PDF) - Michigan providers should attach the completed form to the request in the e-referral system.Criteria Request Form (for non-behavioral health cases) (PDF).Utilization management criteria – Blue Cross commercial Transplants: For authorization determinations (PDF) - Includes information about utilization management programs.Surgeries: For decision support and authorization determinations (PDF) - Includes information about our care management and utilization management programs.Post-acute care: For skilled nursing, rehabilitation and long-term acute care facilities (PDF) - Includes information about our utilization management programs.Inpatient medical admissions, acute care (hospitals): For authorization determinations (PDF) - Includes information about our utilization management program.Diabetes: For coaching, management, behavioral counseling and supplies (PDF) - Includes information about care management and utilization management programs.Durable medical equipment and prosthetics and orthotics: For authorization determinations (PDF).Procedure Codes Requiring Prior Authorization (PDF).Holiday closures: How to submit authorization requests for inpatient admissions (PDF).Post-acute care admissions: Submitting authorization requests (PDF).

Inpatient authorization requests: Tips for using the e-referral system – Blue Cross PPO (PDF).Submitting acute inpatient authorization requests: Frequently asked questions for providers (PDF).Summary of utilization management programs for Michigan providers (PDF).

Blue cross blue shield of michigan linkedin