tango x
Blue Cross® Blue Shield® of Michigan and Blue Care Network

tango is the largest independent, risk-bearing, post-acute benefit management solution in the marketplace. tango goes beyond utilization management to improve access to care and deliver better outcomes.

tango manages skilled home health referrals by placing referrals with high-quality providers, performing utilization management, and processing claims. tango also provides performance-based analytics to its provider network. In some markets, tango offers value-based incentives to optimize the network by driving quality outcomes.

Referrals must be submitted by the referral source (acute care, post-acute care provider, community-based provider, or extenders) to tango through referralrequest.com or by faxing 877-612-7066.

A completed prior authorization form is required for fax submissions. The form is available here.

Include the following when submitting referrals:

• Signed or verbal home healthcare order from an MD, DO, DPM, NP, or PA
• Supporting Clinical Documentation as appropriate:
  • History & Physical (H&P) with ICD 10 code/diagnosis description
  • Inpatient Discharge Summary
  • Notes from hospital or skilled nursing facility (SNF), including therapy notes
  • Physician or provider office notes
  • Wound care notes with measurements

tango determines which agencies receive referrals based on the agency’s coverage area, which is determined during the contracting process. Note: Referring providers may request that referrals be directed to a preferred home health agency based on the member’s, the facility’s or the provider’s preference. If your agency is not fully contracted and credentialed, please reach out to tango for assistance.

Prior authorizations will be processed in a timely manner, usually within the same business day if all required documents are submitted with the request and medical necessity requirements are met.

Select “Re-auth” in the patient’s record within ProNet Connect and complete all required fields. Attach clinical documentation to the request.

Turnaround time (TAT) for re-authorization is typically 2-5 business days if all necessary clinical documentation is included (see below). Please keep TAT in mind when submitting requests to avoid delays in care.

Include the following when submitting re-authorization requests:

• Visit Notes — Include all visit notes that have not been previously submitted for the requested discipline
• OASIS Documentation — Completed SOC (Start of Care), ROC (Resumption of Care), Recertification, or Transfer/Discharge OASIS forms
• 485 Plan of Care (POC) — The plan of care does not need to be signed for the re-authorization request
• Evaluations — Physical Therapy (PT), Occupational Therapy (OT), and Speech Therapy (ST) evaluations must be included
• PT Notes:
  • Include details on the level of function for bed mobility, transfers, and ambulation
  • Note flexion and weight-bearing status if applicable
• OT Notes — Document the level of function for transfers and activities of daily living (ADLs)
• Wound Care Documentation:
  • Wound clinic/MD notes
  • Color photos of the wound, which should be dated and labeled
  • Measurements of the wound, including length, width, and depth
• Foley Catheter Patients — MD order from Urology (if being followed by Urology) for catheter changes scheduled more frequently than monthly

Agencies are evaluated on a variety of key performance indicators across multiple categories, including referral engagement, quality and interoperability.

Scorecard results are shared within 30 days following the end of each calendar quarter. The first set of results will be published on tango’s provider portal by July 2026.