Blue Cross won’t cover services rendered and prescriptions issued by sanctioned providers

Blue Cross Blue Shield of Michigan will no longer cover services rendered or prescriptions written by sanctioned providers. A sanctioned provider is a provider who has been terminated from Blue Cross’ provider networks through either:

The departicipation process; or
A recommendation by Blue Cross’ Audit and Investigation Committee

A sanctioned provider also refers to any provider who appears on any exclusion list issued by the Office of the Inspector General, the Government Services Agency, the Centers for Medicare & Medicaid Services or state licensing boards.

This policy is effective immediately, if in accordance with the member’s benefits. It replaces Blue Cross’ previously published Prescription Block Policy.

Blue Cross will, as reasonably possible, give its affected members 30 days’ notice that services rendered and prescriptions issued by a sanctioned provider will no longer be covered.

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.