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December 2014

Blue Cross electronic qualification form available Jan. 1, 2015

The Blue Cross Blue Shield of Michigan Qualification Form will be posted on web-DENIS for Michigan health care providers on Jan. 1, 2015. Providers can now submit the qualification form electronically for BCBSM members who have a wellness plan that requires a form.

You can access the electronic qualification form by logging into BCBSM Provider Secured Services and clicking on BCBSM Electronic Qualification Form. We’ll also post detailed instructions for submitting the form on web-DENIS Jan. 1.

We strongly encourage you to submit BCBSM qualification forms electronically to speed up processing time.

Note: Providers should continue to use the BCN electronic qualification form for Blue Care Network members.

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.