Reminder: How to access and use the BCBSM electronic qualification form

Effective Jan. 1, 2015, the Blue Cross Blue Shield of Michigan qualification form has been posted on Provider Secured Services for Michigan health care providers. Providers can now submit the form electronically for Blue Cross members who have a wellness plan that requires a qualification form.

To access the form and instructions:

1. Log in to the Provider Secured Services page at bcbsm.com.
2. Scroll down to the BCBSM Qualification Form section.
3. Click on the BCBSM Qualification Form link, which will send you to the online form.
4. For instructions for completing the form, click the BCBSM Qualification Form Instructions link located below the BCBSM Qualification Form link.
5. After completing the electronic qualification form for your patient, make sure you print two copies of the form.
6. Give one completed and signed copy to the patient for his or her records, and keep a copy of the form with the patient’s medical records.

We strongly encourage submitting BCBSM qualification forms electronically to improve processing time. Blue Cross does not reimburse providers separately for the submission of a qualification form because it is included in the well-visit reimbursement. Therefore, members should not be charged additionally for the completion and submission of an electronic qualification form.

For Blue Care Network members, providers can continue to submit the Blue Care Network electronic qualification form. BCN will continue to reimburse them for electronic submissions.