September 2014

Use new fax number when submitting Facility and Professional Supply Requisition order form

We revised the BCBSM Facility and Professional Supply Requisition form to include a new fax number to use when submitting it.

Please discontinue using the old fax number to avoid a delay in processing your order. Submit supply requisition forms to our new toll-free fax number at 1-866-306-0555, or mail them to the address provided on the form.

The revised Facility and Professional Supply Requisition order form is available on bcbsm.com and on web-DENIS:

From the web-DENIS homepage, click on BCBSM Provider Publications and Resources.
Click on Newsletters and Resources.
Go to the “Frequently Used Forms” section of the page to access the form.

Or you can access the form via your provider manual:

From the web-DENIS homepage, click on BCBSM Provider Publications and Resources.
Click on Provider Manual.
Click on Provider Type and select yours from the “Make Selection” box.
Click on the Search button and then on the Blue Pages Directory chapter.
Click on Forms and supplies and then on Facility and Professional Supply Requisition.

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.