Blue cross complete prior authorization phone number

Members and Providers

Visit our webiste at mibluecrosscomplete.com 
Members may also login to their online account from the home page.

Customer Service

For questions regarding policy and coverage information, call: 1-800-228-8554

Pharmacy Help Desk (PerformRx)

For members only, pharmacy questions and benefit assistance, call: 1-888-288-3231

For pharmacists only, for questions regarding billing issues, claims processing and assistance with claim edits, call: 1-888-989-0057

Prior Authorization (PerformRx)

For prescribers only, for questions regarding prior authorization, or to initiate prior authorization requests, call: 1-888-989-0057 

General Pharmacy Benefit Information

We're here to answer your questions about your benefits, services and medical needs.

Blue Cross Complete

Blue Cross Complete of Michigan
4000 Town Center
Suite 1300
Southfield, MI 48075

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Prior authorization

Some medicines require prior authorization by Blue Cross Complete. Your doctor will need to submit a prior authorization request using one of the following forms:

• Prior authorization online form
• Prior authorization request form (PDF)

Your doctor must submit a request for a prior authorization for you. They must also submit an override of a drug restriction. Requests from pharmacists aren’t accepted.

Prior authorization process

Once we receive a request, we’ll review the information. After a decision has been made, you’ll receive a letter with the approval or denial. If it’s denied, we’ll let you know why. Your doctor will receive a letter or a fax with the same information.

We will cover the medicine if it’s medically necessary. If we don’t believe it’s medically necessary, we’ll send you a letter that tells you why. If you or your doctor disagree with our decision, you can appeal it.

Formulary medicines are preferred. If a non-formulary medicine is prescribed, we may require you to try the available formulary medicines first. If it doesn't work, or your doctor doesn’t think they’re appropriate for you, they can submit a prior authorization request for a non-formulary medicine.

If more assistance is needed, your doctor can call PerformRx Pharmacy Provider Services at 1-888-989-0057. Your doctor can fax a hard copy of the form to 1-855-811-9326.

Appeal of prior authorization denials

Your doctor, with your written approval, may ask us to review a prior authorization request that we denied:

Write to
Member Appeals
Blue Cross Complete of Michigan
P.O. Box 41789
North Charleston, SC 29423

Pharmacy prior authorization – emergency supply

A doctor might not get prior authorization. In some cases, you can work with your pharmacy to get an emergency supply of the medicine for three days. If we don't have enough information to make a decision, we'll ask for more information. All clinical information requests must be completed within 24 hours of this request.

Doctors may also ask for copies of the information that was used to make the prior authorization decision. They can contact PerformRx Pharmacy Provider Services at 1-888-989-0057.

Specialty medicines

All specialty medicines, such as those for complex diseases, require prior authorization. The Prior Authorization Request (PDF) form must be completed. The form should be submitted by following the steps on the form.

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Member tools and tips

Blue Cross Complete Mobile App

Access your account anytime, anywhere. The Blue Cross Complete mobile app keeps you up-to-date on your health care information. You can update your member information. You can also find doctors and hospitals. And, you can see a list of your current medications. To download our app, click on the links below or search for "BCCMI" in the App Store® and Google Play™.

Access your data on other mobile apps

Before agreeing to share your health data with a third party health or fitness app, you’ll be directed to sign in and authenticate the third party app using your Blue Cross Complete online account. If you don’t already have an online account, you’ll be prompted to register before this process can proceed.

Once you review the Third Party Data Privacy Information (PDF), you’ll be directed back to the third party app approval process. There you may approve or cancel third party app selection. If, at any time, you’d like to revoke consent to providing your health data to a third party app, you may do so from within your online account.