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September 2014

The Blues to begin formal participation review process for pharmacies

Blue Cross Blue Shield of Michigan and Blue Care Network are dedicated to making sure participating pharmacies meet and maintain credentialing requirements. Currently, pharmacies must undergo an initial credentialing and contracting process to determine if we’ll participate with them.

The Blues are beginning a formal continuing participation verification review process, which will allow us to monitor information on file for pharmacies during their participation term. This will ensure that we have the most current and accurate information on file.

The process will also provide a more structured and timely review of pharmacy network provider information and ensure compliance with the Blues’ pharmacy contracts.

All pharmacies will be required to verify certain information in order to participate with us. The process will occur approximately every two years, depending on the pharmacy’s licensing renewal date.

We’ll let pharmacies know when their verification process will begin and will send a participation packet in the mail. Pharmacies will be required to complete the new application form and provide the following documents within 30 days of receiving the packet:

  • Pharmacy license
  • Pharmacy’s liability insurance certificate
  • DEA license
  • Pharmacists’ license (owner and dispensing)
  • Pharmacy’s certificate of occupancy (if it isn’t already on file for current location)
  • Complete list of pharmacy owners

We advise to have these documents readily available prior to receiving the participation packet. For questions regarding this process, please send an email to pharmacynetworkadmin@bcbsm.com.

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.
Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and
independent licensees of the Blue Cross and Blue Shield Association.