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Blue cross michigan precertification form 2026

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The document is an Acute Inpatient Fax Assessment Form used for precertification and recertification requests related to hospital admissions. It outlines the necessary information required for processing, including patient details, admission type, facility information, and medical history. The form emphasizes the importance of verifying patient eligibility and benefits prior to submission and specifies that incomplete forms will be returned unprocessed. Additionally, it provides guidance for organ transplant admissions and includes sections for case management assistance and discharge planning.

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Click ‘Get Form’ to open the blue cross michigan precertification form in the editor.
Begin by filling out the 'Patient Information' section. Enter the patient's name, date of birth, policy number, and contact details including address and phone number.
In the 'Precertification' section, indicate the type of admission (ER admit, direct admit, elective admit) and provide the estimated length of stay along with the admission date.
Complete the 'Facility Information' fields by entering the facility name, NPI number, and contact details. Ensure all information is accurate for processing.
For recertification requests, specify the number of days requested and provide current estimated length of stay along with any relevant medical history or surgical procedures.
Review all entries for completeness. Incomplete submissions will be returned unprocessed. Once satisfied, save your changes and follow instructions to fax it as required.

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Versions	Form popularity	Fillable & printable
2021	4.9 Satisfied (36 Votes)
2018	4.2 Satisfied (170 Votes)
2013	4.3 Satisfied (185 Votes)
2012	4 Satisfied (25 Votes)

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is the phone number for BCBS of Michigan credentialing?

Questions? During the credentialing or recredentialing process, you can ask questions about the status of your application, ask to review information submitted to support your application and correct anything in error by calling us at 1-800-822-2761.

What is a precertification form?

Prior authorizationsometimes called preauthorization or precertificationis a health plan cost-control process by which physicians and other health care providers must obtain advance approval from a health plan before a specific service is delivered to the patient to qualify for payment coverage.

Does Blue Cross Blue Shield of Michigan require prior authorization?

Blue Cross Blue Shield of Michigan and Blue Care Network require prior authorization for certain benefits. This means we need to review a service to be sure it is medically necessary and appropriate.

Is BCBS the same as BCBS of Michigan?

Blue Cross Blue Shield of Michigan (BCBSM) is an independent licensee of Blue Cross Blue Shield Association.

What is the phone number for Blue Advantage prior authorization?

Use the Precertification Lookup Tool accessed through Payer Spaces in Availity. Call Provider Services at 1-844-421-5662.

bcbs michigan prior authorization form

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What is the precertification phone number for BCBS of Michigan?

To verify coverage or benefits or determine pre-certification or pre-authorization requirements for a particular member, call 1-800-676-BLUE or send an electronic inquiry through your established connection with your local Blue Plan.

What is the phone number for BCBS Michigan pre-authorization?

Providers can request a coverage determination (prior authorization, step therapy, formulary exception or quantity limit exception) by phone at 1-800-437-3803 or by using the information in the Medicare Plus Blue PPO section of the For Providers Drug Lists page on bcbsm.com/providers.

How do I speak to a representative at BCBS of Michigan?

General support Call the number on the back of your member ID card or call 1-313-225-9000. Members can also log in to find health plan information and helpful resources or to request a new ID card.