Vision and Hearing Providers

Blue Cross Blue Shield of Michigan will provide many of the supplies you need to prepare and submit vision claims. The items listed below are some of the supplies that you can order using the Facility and Professional Provider Supply Requisition Form (PDF). Complete the form and mail or fax to us using the contact information provided.

  • No Cost Items
    • Blue Cross Blue Shield of Michigan self-addressed envelopes for returning claim forms (CS 5129)
    • Michigan health benefits claim review (CC 6742)

  • For Sale Items
    • CMS-1500 two-ply continuous feed claim form ($40.67/1,000 forms)
    • CMS-1500 two-ply snap out claim form ($20.88/500 forms)
    • CMS-1500 one-ply continuous feed claim form ($15.61/1,000 forms)