Helpful hints for completing applications for Provider Secured Services

Use the following guide while completing an application for Provider Secured Services. These section-by-section hints help you fill out the application accurately, which helps us process your application — and give you access to the portal — faster.

Section 1 — Applicant demographics

• We need all information requested in this section to process the application.
• Fill out this section in its entirety and electronically (we can’t process handwritten data).
• The address must be the user’s physical location, not a post office box (it’s an invalid address).
• If the practice has multiple locations, give the actual, physical location of the specific user.
• If there’s a specific suite number in the user’s address, include it here, too.
• The Use and Protection Agreement is also within the application document; send it with each application.
• The practice’s name must match on both the Provider Secured Services application and the Use and Protection Agreement.
• Send all pages of both the application and Use and Protection Agreement to us.

Section 2 — Clone IDs

• If your practice doesn’t have access to Provider Secured Services currently, leave this section blank.
• If your practice does have Provider Secured Services access, cloning a user ID will give new users the same PINs that are assigned to it currently, but it doesn’t duplicate its access (the access request is in Section 6).
• Only the user ID that needs cloning goes in Section 2.
• If you’ve listed a clone ID in Section 2, leave Section 4 blank.

Section 3 — e-referral

• For offices requesting e-referral access for the first time, leave Section 3 blank.
• If your office has e-referral access, add your set ID here.
• No other information should be in this section.

Section 4 — New access NPIs

• This is where you add NPIs when there’s no user ID listed for cloning in Section 2.
• If you’ve put a clone ID in Section 2, leave this section blank.
• If your office needs access to more NPIs than space allows in this section, fill out an additional page and attach it to the application.
• If your office has existing users who need additional PIN access, submit the Authorization to Modify BCBSM and or BCN Provider Codes on your Provider Secured Services ID.

Section 5 — Health e-Blue access

• Health e-Blue helps you generate reports about patient health and helps you fill out Healthy Blue Living^SM qualification forms.
• Specialty and mental health providers don’t qualify for Health e-Blue access.
• Add users or remove access by submitting an Authorization to Add/Remove access for BCN, MAPPO, Commercial Health e-Blue form.

Section 6 — User features

• List all users’ names, phone numbers and select the access features each user needs.
• We can’t create a user ID without a user phone number. A user phone number is mandatory, and it must be the practice phone number, not the user’s personal cell number.

Access features include:

• Claims Tracking & EFT — This access allows Blue Cross Blue Shield of Michigan and Blue Care Network providers and facilities to track claims online, and receive electronic funds deposits and vouchers online.
• BCN PCP Claims Summary — Access to this feature allows BCN primary care physicians to view BCN claim summaries.
• E-referral — Allows users to submit and review referrals
• Health e-Blue — Allows users to view patient information about gaps in care and make updates to patient health information online. BCN primary care physicians also use this feature to enter BCN Qualification Form details for Healthy Blue Living^SM HMO members.
• Medical Drug PA — Allows physicians to complete medical drug prior-authorization requests online (only Type 1 NPIs qualify for this access).
• Behavioral health providers don’t qualify for BCN PCP Claims Summary or Health e-Blue.
• If new users only need access to eligibility, don’t check any of the access boxes in this section.
• As a reminder, if the user is only requesting eligibility access, there shouldn’t be a user ID (for cloning) in Section 2 or NPIs listed in Section 4.

Section 7 — Authorization

• This section is mandatory. Fill it out completely.
• The Date field must have a date.
• Make sure the authorized signer’s printed name matches with his or her signature.
• If the name and signature don’t match or the name and signature is missing, we’ll return your application for correction (which will delay the processing of your application).
• We don’t accept stamped signatures. We’ll return applications to you for correction.

If you have any questions while completing these forms, contact the Web Support Help Desk at 1-877-258-3932, from 8 a.m. to 8 p.m. Monday through Friday.