June 2015

Blue Cross electronic qualification form gets some new features

On Jan. 1, 2015, the Blue Cross Blue Shield of Michigan qualification form became available electronically for Michigan health care providers. Many Michigan providers have submitted the form electronically for Blue Cross members with wellness plans that require the form. We are pleased to announce some new features that will make submission much easier:

You can now easily select a patient from a drop-down list.

You can also view patient health measure values from previously submitted qualification forms.

To access the form and revised instructions:

Scroll down to the BCBSM Qualification Form section.

Click on the BCBSM Qualification Form link, which will send you to the online form.

For instructions for completing the form, click on the BCBSM Qualification Form Instructions link located below the BCBSM Qualification Form link.

After completing the electronic qualification form for your patient, make sure you print two copies of the form.

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 Blue Cross qualification forms electronically to improve processing time.

Note: Continue to use the Healthy Blue Living^SM qualification form for Blue Care Network members.

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.