Reimbursement amount changes for nonpayable codes covered by other plans

Keep in mind that we pay for covered services based on the lower of either your billed charges or the Blue Cross Blue Shield of Michigan approved amount. However, there are times when the member’s home plan may cover a service that Blue Cross considers nonpayable.

In these instances, we’ll base our approved amount on a percentage of your charged amount.  Ambulatory surgery facilities also will be paid based on a percent of charges, like codes currently listed on the fee schedule with a fee of "St % Chrgs." Hospital outpatient charges will be paid at a percentage of charges, like codes currently listed on the fee schedule with a fee of “Cost-based.”

Procedure codes paid under this methodology due to a member’s coverage from an out-of-state Blue plan will continue to show as nonpayable, or NP, on the fee schedule.