The Record - Reminder: Update your primary location address

Reminder: Update your primary location address

Do we have your correct primary location address in our records?

It’s important we have the correct information. If you need to update your facility’s primary address, here’s what you need to know:

To add, remove or change a primary practice location, fill out the BCBSM/BCN Facility Change Form (PDF).

Visit bcbsm.com/provider.
Click on Join the Blues Network, Enrollment and Changes.
Click on provider enrollment form.
Select Hospitals and Facilities and follow the prompts.

Fax the Change Form along with supporting documentation for your facility classification to: 1-866-900-0250

Facility classification

Supporting documentation

Ambulatory Infusion Center

State of Michigan pharmacy license listing address of primary practice location

Ambulatory Surgical Facility

Medicare approval letter listing address of primary practice location and approval as ambulatory surgical services supplier
State of Michigan freestanding surgical outpatient facility license with matching address of primary practice location

End Stage Renal Disease Facility
Home Health Care Facility

Medicare approval letter listing address of primary practice location

Federally Qualified Health Center

Medicare approval letter listing address of primary practice location and approval as a federally qualified health center

Halfway House

State of Michigan residential/outpatient substance abuse program license listing address of primary practice location

Home Infusion Therapy

Medicare Part B approval letter listing address of primary practice location and approval as durable medical equipment supplier

Hospice

Medicare approval letter listing address of primary practice location and approval as hospice agency

State of Michigan hospice agency license listing address of primary practice location

Long Term Acute Care Hospital

Medicare approval letter listing address of primary practice location and approval as long term acute care hospital

State of Michigan acute care hospital license listing address of primary practice location

Outpatient Physical Therapy Facility

Medicare approval letter listing address of primary practice location and approval as one of the following:

Rehabilitation agency for outpatient physical therapy services
Comprehensive outpatient rehabilitation facility

Outpatient Psychiatric Center

To add, remove or change a primary practice location, fill out the BCBSM/BCN Facility Change Form(PDF):

Visit bcbsm.com/provider
Click on Join the Blues Network, Enrollment and Changes
Click on provider enrollment form
Select Hospitals and Facilities and follow the prompts.

Rural Health Clinic

Medicare approval letter listing address of primary practice location and approval as a rural health clinic. Must bill Medicare services to Medicare as an “institutional provider”

Skilled Nursing Facility

Medicare approval letter listing address of primary practice location and approval as a skilled nursing facility
State of Michigan license that lists address of primary practice location, verifies compliance with all federal regulatory requirements and identifies facility as one of the following:

Nursing home
Long term care facility
Hospital long term care unit
Director of nursing and medical director names

Substance Abuse Facility

DEA license (if providing Methadone services) listing address of primary practice location
State of Michigan license, listing address of primary practice location, as one or more of the following:

Residential (Standard)
Outpatient (Standard)
Methadone (Standard)

If you have questions about the address change or how it may affect your Blues affiliation, call Provider Enrollment and Data Management at 1-800-822-2761 or your provider consultant.

Helpful tip: Periodically review your address listed in the Find a Doctor tool on bcbsm.com. Contact your provider consultant if you find any incorrect data.

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.