BlueCard^® connection: answer to a recent question

As part of our ongoing series on the BlueCard program, here’s the answer to a question we recently received.

What is the difference between a BlueCard claim reconsideration and a provider appeal?

A claim reconsideration is the first step of our routine claim inquiry process and must be initiated before you appeal a claim processed through Blue Cross Blue Shield of Michigan.

Your first point of contact for the claim reconsideration should be to our Provider Inquiry department. This department can:

• Provide you with the information that we have on file for the claim
• Work with the member’s home plan to initiate your request to have the claim reconsidered

If the outcome of the reconsideration is not favorable, your next point of contact should be to your provider consultant. If the claim denial is maintained after working with your provider consultant, you have the option of appealing the claim.

All claim appeals must be sent to Blue Cross Blue Shield of Michigan in writing and include:

• Any supporting documentation for your appeal
• The documentation that you completed our routine claim inquiry process

Note: If you’re appealing a claim on behalf of a BlueCard member, you must also include the member’s written authorization to do so.

If you need additional information on the BlueCard program, including links to our detailed inquiry process, the process for submitting a claim appeal and the address to send in a claim appeal, refer to the BlueCard chapter of the online provider manuals.

If you’re experiencing issues with the information provided in the BlueCard chapter or any of the online tools — or if you’d like more information on a particular topic — contact your provider consultant. If you’d like to suggest a topic to be covered in a future issue of The Record, send an email to ProvComm@bcbsm.com and put “BlueCard series” in the subject line.