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June 2015
What you need to know about ancillary providers participating in Metro Detroit EPO network
As you’ve read in The Record, Blue Cross Blue Shield of Michigan launched the Blue Cross
® Metro Detroit EPO on Jan.1, 2015. Consumers were able to purchase plans, both on and off the Health Insurance Marketplace, that use this network for coverage effective Jan. 1, 2015, or later.
Blue Cross does not require ancillary providers or other non-physician providers to sign a contract to participate in the Metro Detroit EPO network. Ancillary providers and other non-physician providers in good standing with a current TRUST PPO or TRAD contract (where the TRUST PPO is not available) are deemed participating providers in the EPO network and should render services for eligible EPO members.
These ancillary providers participate in the Metro Detroit EPO:
- Ambulance
- Ambulatory infusion center
- Ambulatory surgical facilities
- Audiologists
- Board certified behavioral analysts (autism services)
- Certified nurse anesthetists, nurse practitioners, nurse midwives
- Clinical laboratories
- Clinical licensed social workers
- Durable medical equipment; prosthetics & orthotics
- End-stage renal centers
- Home infusion therapy
- Home health care (Blue Care Network, Medicare Supplemental and MAPPO contracts)
- Hospice
- Long-term acute care facilities
- Optometrists
- Outpatient psychiatric Care
- Physician assistants
- Rehabilitation therapy - outpatient
- Skilled nursing facilities
- Substance abuse facilities
- Urgent care centers
Key points to keep in mind:
- Check eligibility and benefits — As always, check eligibility and benefits before providing services by using web-DENIS or the Provider Automated Response System (PARS, formerly CAREN). The Metro Detroit EPO plan name will be listed on web-DENIS, in PARS and on the member’s ID card.
- Respond to patient inquiries — Make sure that your office staff knows that you are in the Metro Detroit EPO network so they can respond accurately to inquiries from patients.
To find more information about the new Metro Detroit plans:
If you have any questions, contact your provider consultant or call Blue Cross Provider Inquiry at 1-800-344-8525. |
