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Get MI WF 15674 2016-2024
Fax it to: 1-866-464-8223 2U H ID HPDLO WR 0HGLFDUH3OXV%OXH)DFLOLW )D #EFEVP FRP ATTN Michigan providers: for admission authorization of Medicare Plus Blue PPO members who reside in Michigan, please contact eviCore Healthcare at 1-877-917-BLUE or visit eviCore's website at www.carecorenational.com/page/bcbsm-implementation.aspx and download the applicable assessment form. Facility and provider must participate with local Blue Cross Blue Shield plan or member may incur higher costs. Complete ev.
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