The Record - Resolving your issues: Do I call or do I write?

Resolving your issues: Do I call or do I write?

Did you know?

Last year, Provider Relations and Servicing processed more than 1.3 million phone inquiries and more than 100,000 written inquiries.
On average, we answered each phone call within 90 seconds.
On average, each phone call lasts 11 minutes.
On average, our response time for written inquiries is more than 21 days.

First article in a series providing guidance on the best way to get your questions answered.

We’re committed to resolving your inquiries as soon as possible and making it easier for you to do business with us. That’s why we want to let you know that many of your inquiries can be handled more quickly and efficiently by calling Provider Inquiry rather than by writing to us.

When you need to write
To improve your service experience, beginning Nov. 1, 2015, we’ll only process written inquiries for the following reasons:

Preauthorization for Blue Cross Blue Shield of Michigan-enrolled members. (For more details, see the June 2012 article on requesting medical reviews.)

Ten or more claims regarding the same issue, including refund requests

When you can call
Below is a list of inquiries that will be handled by phone (list is not all-inclusive):

Benefit and eligibility questions

Duplicate rejections

Benefit rejections

Incorrect claim rejections

Precertification rejections

BlueCard rejections that don’t require medical documentation

Provider affiliation rejections

Claims processed after Medicare has paid or rejected

Issues related to quantities billed (e.g., number of procedures, amount of drugs)

In or out-of-network payments

Refund requests

Requests for additional payment

Payment discrepancies

Questions regarding patient benefits and claims

COB claim inquiries

A provider service representative will review your claim and determine how to best resolve the issue. If the issue requires further investigation, the representative will document your concerns and forward your inquiry for review and resolution.

In the next article in this series, we’ll take a look at the many self-service tools and resources that can help answer your questions.

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.