CommercialPrior AuthMedium impact
Changes to prior authorization requirements for select services managed by Blue Cross and BCN are effective March 15
BCBS Michigan·MI · Wound Care, Dermatology, Plastic Surgery +1 more·Prior Authorization
Effective date
Mar 15, 2026
We identified it
Jun 16, 2026
Summary
Blue Cross Blue Shield of Michigan and Blue Care Network updated prior authorization requirements effective March 15, 2026. Private duty nursing requests are now limited to 60-day episodes maximum, and skin/tissue substitute requests must include both application and covered product codes.
Action Required
Immediately: Update prior authorization workflows for private duty nursing to request maximum 60-day episodes only - longer requests will be automatically rejected by e-referral system. For skin and tissue substitutes, billing team must include both application code AND covered product code in all prior auth requests. Review BCN medical policies at bcbsm.com to identify noncovered product codes that will result in denials. Update staff training on new e-referral system requirements.