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February 2017

Reminders about 2017 Blue Cross qualification forms

You’re probably seeing patients who ask you to complete and return their 2017 Blue Cross Blue Shield of Michigan qualification forms.

Here are some reminders about completing the forms:

  • No changes were made to the qualification forms for 2017.
  • Perform the cotinine test only if the qualification form indicates it’s required, as it’s not a standard covered benefit.
  • Make sure all fields on the form are completed in their entirety before submitting for accurate processing.
  • If you’re a Michigan health care provider, submit Blue Cross qualification forms electronically to improve processing time. Out-of-state physicians, or those who can’t submit the form electronically, can fax completed forms to 1-866-392-6496.
  • Continue using the Healthy Blue LivingSM 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 2016 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.