Bcbs of michigan provider phone number for prior authorization

Resources for Providers

Blue Cross Complete of Michigan offers a variety of resources to its provider network.

Provider manuals and guides

Michigan Quality Improvement Consortium guidelines

Visit the Michigan Quality Improvement Consortium to access the guidelines, physician tools and reports, which provide MQIC community HEDIS® and non-HEDIS results for over 100 quality improvement measures.

Telehealth resources

Visit telehealth.hhs.gov for more information on telemedicine services and resources. 

Pharmacy resources

Blue Cross Complete participates in the Medicaid Health Plan Common Formulary. Under the Common Formulary, Medicaid Health Plan formulary coverage only includes products with a National Drug Code from manufacturers who participate in the Medicaid Drug Rebate Program.

• View the Medicaid Drug Rebate Program Labeler List (PDF)

Clinical and administrative resources

1. Clinical Resources
2. Administrative

Blue Cross Complete payment systems

Blue Cross Complete has implemented payment systems to meet providers’ requests for more payment options. The payment systems allow providers the ability to receive the following payment options for claims reimbursement:

Electronic funds transfer
Electronic funds transfers allow you to receive your payments directly in the bank account you designate rather than receiving them by virtual credit card or paper check. When enrolling in EFT, you will automatically receive electronic remittance advices for those payments. All generated ERAs and a detailed explanation of payment for each transaction will also be accessible for download from the ECHO provider portal at providerpayments.com.  

To sign-up to receive EFT from Blue Cross Complete, visit ECHO Healthcare.    

To check the status of an EFT enrollment or obtain technical support, contact ECHO customer service at or call  1-888-834-3511.

Virtual credit card
A virtual debit transaction in which randomly generated, temporary credit card numbers are either faxed or mailed to providers for claims reimbursement. The VCC payment notification will contain a number unique to that payment transaction and an instruction page for processing the payment.

Note: Providers who aren’t enrolled to receive EFT will automatically receive the VCC. If you don’t wish to receive your claim payments through VCC, you can opt out by calling ECHO Health at 1-888-492-5579 to receive a paper check.

Electronic remittance advice
Providers may also receive their electronic remittance advice from Change Healthcare and ECHO Health by including both the Change Healthcare Blue Cross Complete payer ID: 32002 and the ECHO Health payer ID: 58379. To receive remittance advice, visit ECHO Healthcare or contact the ECHO Health Enrollment team at 1-888-834-3511.

Download the Blue Cross Complete Payment Systems (PDF) brochure for more information.

To access the ECHO Healthcare provider payments portal quick reference guide, visit ECHO Healthcare and log into your account. The User Guide can be accessed by selecting the Help button on the portal. If you require further assistance, contact your Blue Cross Complete provider account executive.

County-based contacts for providers

For more information on training, Medicaid and other topics, contact a provider account executive in your county. Select a county below for the contact details of that county's account executive.

Blue Cross Complete of Michigan's self-service tools are valuable resources that can assist you in providing the highest quality of care to our members.

Provider directories

Drug formulary

A comprehensive drug list for Blue Cross Complete can be accessed and reviewed in two ways:

The searchable version of the drug list provides additional details regarding quantity limits, prior authorizations or other coverage details not available on the printable version. This includes guidance for obtaining specialty medications.

For pharmacies

The PerformRx Pricing Administration Department calculates generic Maximum Allowable Cost and money paid to participating pharmacies. MAC prices are updated each week. To ask for a MAC pricing review, email the PerformRx Pricing Administration Department. You can also call PerformRx Pharmacy Provider Services at 1-888-989-0057.

Prior Authorization Lookup

Find out if a service needs prior authorization. Type a Current Procedural Terminology, or CPT, code or a Healthcare Common Procedure Coding System, or HCPCS, code in the space below to get started.

Directions

1. Enter a CPT or HCPCS code in the space below.
2. Click Submit.
3. The tool will tell you if that service needs prior authorization.

Important notice

This tool provides general information for outpatient services performed by a participating provider.

The following services always require prior authorization:

• Elective inpatient services
• Urgent inpatient services

The results of this tool aren’t a guarantee of coverage or authorization. All results are subject to change in accordance with plan policies and procedures and the Provider Manual (PDF).

If you have questions about this tool or a service or to request a prior authorization, call Blue Cross Complete's Provider Inquiry at 1-888-312-5713.

Healthcare common procedure coding system medications 

A prior authorization for healthcare common procedure coding system medications is required before they are covered by Blue Cross Complete. Click the HCPCS PA List (PDF) for a list of codes that require prior authorization.

Prior authorization

Some medicines and benefits require prior authorization by Blue Cross Complete. Submit a prior authorization request using one of the following forms:

• Medication prior authorization online form
• Medication prior authorization request form (PDF)

You must submit a request for a prior authorization for your patient. You must also submit an override of a drug restriction. Request from pharmacies aren't accepted.  

Pharmacy billing

The electronic processing of retail pharmacy claims requires a NCPDP processor ID number, also known as a BIN, and a processor control number, or a PCN, for plan identification. Blue Cross Complete's D.0 Payer Sheet (PDF) contains our BIN (600428), PCN (06210000), member services number, field definitions and other helpful information for pharmacy claim billing and rebilling.

NaviNet

By logging on to the Blue Cross Complete payer-provider portal Navinet, you have the opportunity to:

• Receive news alerts in real time
• View Blue Cross Complete member information
• Submit authorization requests
• View gaps in care reports 
• Check the status of claims

Visit NaviNet Basics if you have not yet enrolled or would like more information.

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