CBM

www.communitybridgesihc.com
P.O. Box 489 586.741.8360 Linden, MI 48451 810.714.9344 Fax:

August 24, 2011 To All Providers: Re: CBM Prior Authorization (PA) Process

For CBM ABW programs (Oakland Health Plan and CBM Wayne ABW). Effective September 1, 2011, ONLY the following services will require PAs from PCP authorized by CBM if referred to CBM Network Specialist: ALL Surgery Lab Tests listed on Website (non-routine) MRI, MRA, PET, CT ALL Ultra Sounds Genetic Testing ALL Cardiac Testing All Doppler EEG, EMG, EKG Chemo and Radiation Therapy Sleep Study (requires proof of life threatening medical necessity) Dialysis ALL Nuclear Testing All services over 24 hours provided in ER Observation All other services require a CBM referral from PCP, but no authorization/approval from CBM will be required if referred to CBM Network Specialist. NO Urgent Care PA will be required for CBM Network Urgent Cares. Sincerely, CBM Julie Jernigan-Ahmed COO/CFO
Revised 8/26/11, 9/1/11, 9/19/11, 10/4/2011, 4/22/12

cc:

Wayne County PCMS, OHP, NGS

Revised 8/26/11, 9/1/11, 9/19/11, 10/4/2011, 4/22/12