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March 2015

New Blue Cross electronic qualification form instructions now available

We’ve uploaded new step-by-step instructions for the Blue Cross qualification form to the provider portal.

If you previously printed the qualification form instructions, please destroy or shred any old copies and begin using the new instructions. Dispose of the old copies in a secure manner as you would with any protected health information.

To access the new instructions:

  1. Log in as a provider at bcbsm.com.
  2. Scroll down and click on the BCBSM Qualification Form Instructions link located below the BCBSM Qualification Form link.

To complete a qualification form for your patients:

  1. Click on the BCBSM Qualification Form link immediately above the link for the BCBSM Qualification Form Instructions.
  2. After completing the electronic qualification form for your patient, make sure you print two copies of the form.
  3. 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.

Note: For Blue Care Network members, you should continue to submit the Healthy Blue Living qualification form.

For additional information or if you have questions, contact your provider consultant.

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 2014 American Medical Association. All rights reserved.