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May 2015

Reminder: Combined signature document for each provider type

As you read in the April Record, BCBSM has combined the practitioner signature documents into a single document for each provider type.

We wanted to let you know that a new signature document for each provider type is now available in the Provider Enrollment area of bcbsm.com/providers. To complete a combined signature document, the practitioner must indicate which network or networks he or she wants to apply for and sign the form.

If you have any 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.