Referrals

Depending on which Blues plan coverage your patient has, you may need to give a referral outside our network. Use these forms for that process.

BCBSM Referrals

• Dentist to Physician referral form (PDF)
• Physician to Dentist referral form (PDF)
• TRUST/PPO Program Referral Form (PDF)
• BCBSM U.P. Blue Out-of-State Referral Preauthorization (PDF)

BCN Referrals

Use our e-referral system to submit your referrals electronically. With e-referral, you can:

• View existing referrals and plan approvals
• Request plan approvals and most inpatient admissions
• Submit OB admission requests
• Report services associated with global referrals