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.

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BCBSM Referrals

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

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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 with the exception of most inpatient admissions
• Submit 23-hour observations and OB admission requests
• Report services associated with global referrals