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May 2016

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

In the August 2015 Record, we ran an article on this topic aimed at professional providers. We’ve repurposed the article for our facility providers.

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 May 1, 2016, we’ll only process written inquiries for the following reasons:

  • Preauthorizations for Blue Cross Blue Shield of Michigan members. (For more details, see the June 2012 article on requesting medical reviews.)
  • If you have 10 or more claims regarding the same issue. This includes refund requests.

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

  • Benefit and eligibility questions that can’t be answered by PARS
  • 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.

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 2015 American Medical Association. All rights reserved.
Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and
independent licensees of the Blue Cross and Blue Shield Association.