We’re updating reimbursement language for certain provider agreements

Effective Dec. 1, 2017, the participating provider agreements for the following types of providers will have updated reimbursement language:

• Hospice
• Long term acute care hospital
• Freestanding and hospital-based substance abuse facility
• Skilled nursing facility
• Vision specialist
• Ambulance
• Ambulatory infusion center
• Ambulatory surgery facility
• Home infusion therapy
• Home health care facility
• Retail health center
• Freestanding radiology center
• Certified registered nurse anesthetist
• Mental health and substance abuse facility managed care program
• Mental health and substance abuse managed care program professional provider

The reimbursement sections of the above-mentioned agreements will reference Blue Cross Blue Shield of Michigan PPO programs. The following language will be incorporated into the agreements:

Accept Blue Cross payment as payment in full. Except for copayments and deductibles
specified in members’ certificates, provider will accept Blue Cross’ approved amount as full payment for covered services and agrees not to collect any further payment from any member, except as set forth in Addendum “D.” Provider also agrees to accept as payment in full for covered services, except for applicable copayments and deductibles, Blue Cross-approved amount for members covered under any Blue Cross PPO program, or Blue Cross DME or P&O programs, or any Blue Cross DME or P&O program if provider covers services to such member. Provider won’t collect deposits from members. “Deposit” is defined as an amount in excess of a copayment or deductible, which is collected on or prior to the date of service.

This uniformity will eliminate confusion and streamline your PPO experience in accordance with Blue Cross Blue Shield Association requirements.