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.
Blue Cross Blue Shield of Michigan Referrals
- Dentist to Physician referral form (PDF)
- Physician to Dentist referral form (PDF)
- TRUST/PPO Program Referral Form (PDF)
- BCBSM U.P. Blue Referral Form (PDF) - Only Michigan PPO providers for U.P. Blue members can use this form. It can't be used by out-of-state providers.
Blue Care Network 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 and most inpatient admissions
- Submit OB admission requests
- Report services associated with global referrals