Blue Preferred Plus^SM referral process changes

Blue Preferred Plus practitioners referring members to out-of-network physicians will no longer be required to call BCBSM Medical Care Management Operations for referral authorizations. Practitioners may now complete a new Blue Preferred Plus referral form without obtaining approval.

Blue Preferred Plus members must receive non-emergency services from affiliated Blue Preferred Plus physicians within the Blue Preferred Plus 21 counties in Central, East and Southeast Michigan.

Outside of the 21 counties, Blue Preferred Plus members may see physicians in the TRUST PPO network. TRUST physicians may refer patients to non-network doctors using the BCBSM TRUST PPO referral process.

You may refer patients to a specialist who is not in the network if there is no network specialist within 20 miles of the member’s home.

Blue Preferred Plus referral process

1. Blue Preferred Plus network physicians must complete the new Blue Preferred Plus Program Referral Form before members receive services from the non-network physician.
2. The BPP program referral form is available in two formats:
   • You can order a supply of the printed, triplicate form, form number 13059. For order information, see the Blues Pages directory.
   • You can access and print the electronic form from our website. You will need three copies — one for each of the following: Blue Preferred Plus referring provider, the referred-to provider and the member.
3. Referrals are only valid up to 60 days after the date the BPP network physician completes the referral form. Retrospective referrals will not be approved without documentation of the patient’s medical record indicating referral was prior to the member receiving services from the non-network practitioner.
4. The completed referral may cover services up to one year.
5. The non-Blue Preferred Plus network physician should complete the referral form and return a copy to the BPP network referring physician.
6. The signatures of the BPP network referring physician, non-network physician and member must be on the Blue Preferred Plus Program Referral Form.
7. The BPP network referring physician, non-network physician and member must retain copies of the completed and signed referral form.

Submitting claims on the CMS-1500 claim

1. The referring BPP network physician’s seven-digit PIN must be in Field 10d and the 10-digit NPI in Field 17b of the CMS-1500 claim from the non-BPP network physician.
2. The CMS-1500 claim should be submitted with a copy of the referral form attached. If the non-network physician bills electronically, he or she should keep a copy of the referral form in the member’s medical record.
3. If the BPP network referring physician’s seven-digit PIN is not on the CMS-1500 claim or if the referral services are not requested by a BPP network referring physician, the services could be subject to out-of-network costs.

Submitting claims on the UB-04 claim

1. The referring BPP network physician’s seven-digit PIN must be in Form Locator 63, Treatment Authorization, and the 10-digit NPI in Form Locator 56 of the UB-04 claim from the non-network physician. The UB-04 claim should be submitted with a copy of the referral form attached. If the non-network physician bills electronically, he or she should keep a copy of the referral form in the member’s medical record.
2. If the BPP network referring physician’s seven-digit PIN is not on the UB-04 claim or if the referral services are not requested by a BPP network referring physician, the services could be subject to out-of-network penalties.