Blues now send Master Medical reimbursement directly to providers

When processing a claim for a member with Master Medical coverage, Blue Cross Blue Shield of Michigan will pay the participating provider its approved amount, less the patient’s copayment, coinsurance and deductible for medically necessary covered services.

As with our other coverage plans, you’ve agreed to accept our approved amount as payment in full for covered Master Medical services.

We recently transferred all of the Master Medical groups to our Michigan Operating System. The move to MOS helped us align our Master Medical reimbursement process with our other coverage plans.

Prior to the transfer, we sent Master Medical reimbursements directly to the patient, and you were responsible for collecting the payment. Under this newer, simpler reimbursement process, you should no longer be collecting payments from patients, except for normal cost-sharing amounts (deductibles, copayments and coinsurance).

The claims filing limit for submitting a Master Medical claim is two years, so you may still have some pay-subscriber claims during that period. Claims for dates of service prior to the contract migrating to MOS are pay-subscriber. After MOS migration, health care providers are paid directly and regular filing limits apply.

Remember: Master Medical benefits have not changed, just the way we process reimbursements has.

For more information, contact your provider consultant.