BCBS AFFILIATEMIPBM: Express Scripts
Blue Cross Blue Shield of Michigan Prior Authorization Guide
Submit prior authorization requests and appeal denials with BCBS Michigan. Phone numbers, fax numbers, appeal deadlines, step therapy override rights, and clinical documentation tips for MI providers.
Prior Authorization Contacts
PA PHONE
1-800-437-3086
PA FAX
1-313-225-0969
TURNAROUND
15 days standard, 72h expedited
TIMELY FILING
180 days
APPEALS MAILING ADDRESS
BCBS Michigan, Attn: Grievance and Appeals, 600 E Lafayette Blvd, Detroit, MI 48226
Common Denial Reasons
- ⚠ BCBSM Medical Policy criteria not met
- ⚠ Step therapy — preferred DMARD not tried
- ⚠ Non-formulary status
- ⚠ Specialty pharmacy requirement
Step Therapy Requirements & Override Rights
BCBS Michigan follows its Medical Policy Manual with detailed criteria per drug class. Michigan enacted SB 247 (2019) requiring step therapy override provisions. For biologics, typically requires 3-month conventional DMARD trial.
Tips for BCBS Michigan Submissions
- 1. BCBSM Medical Policy Manual is publicly searchable — cite exact policy
- 2. Submit via web-DENIS or Availity
- 3. Michigan Blues plans have strong internal appeals — three levels before external
- 4. Walgreens Specialty Pharmacy for specialty drugs
External Review Authority
If BCBS Michigan denies your final internal appeal, you have the right to request an external review through: Michigan Department of Insurance and Financial Services (DIFS).
External review decisions are binding on the insurer.