The Record - Speech pathologists, physical therapists, occupational therapists may apply to participate with BCBSM and BCN before Medicare approval letter received

Speech pathologists, physical therapists, occupational therapists may apply to participate with BCBSM and BCN before Medicare approval letter received

As of March 1, 2014, independent occupational therapists, independent physical therapists and independent speech language pathologists may be considered for temporary participation with Blue Cross Blue Shield of Michigan and Blue Care Network.

The provider must have applied as a supplier to Medicare and must comply with our provisional agreement process.

A therapist will be considered for temporary participation only if they submit:

The New Practitioner Enrollment Form

A signature document for each network the provider is applying for

Note: You can access both the New Practitioner Enrollment Form and the signature documents by going to bcbsm.com/providers:

Click on the Join the Blues Network tab.
Click on Enrollment and Changes.
Click on Provider Enrollment and follow the prompts.

A BCBSM and BCN Medicare Supplier Provisional Agreement. (Contact Provider Enrollment and Data Management at 1-800-822-2761 to obtain this document.)

All other required documents

For IOTs and IPTs:

State of Michigan professional license
Type 1 national provider identifier
Social Security Number
Tax identification number and Internal Revenue Service document identifying TIN and associated payee name (W-9s not accepted)
Council for Affordable Quality Healthcare number if available

For ISLPs:

State of Michigan professional license if available
Certificate of Clinical Competence from the American Speech-Language Hearing Association
Type 1 national provider identifier
Social Security Number
Tax identification number and Internal Revenue Service document identifying TIN and associated payee name (W-9s not accepted)
Council for Affordable Quality Healthcare number if available

If you have any question regarding provider enrollment, contact Provider Enrollment and Data Management at 1-800-822-2761.

No portion of this publication may be copied without the express written permission of Blue Cross Blue Shield of Michigan, except that BCBSM participating health care providers may make copies for their personal use. In no event may any portion of this publication be copied or reprinted and used for commercial purposes by any party other than BCBSM.

*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2013 American Medical Association. All rights reserved.