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January 2019
Blue Cross qualification forms should be submitted electronically
This year, you’ll probably see patients with wellness plans who ask you to complete and return their 2019 Blue Cross Blue Shield of Michigan qualification forms. Here are some reminders about completing the forms:
- We didn’t make any changes to the qualification forms for 2019.
- Make sure all fields on the form are completed in their entirety before submitting for accurate processing.
- Perform the cotinine test only if the qualification form indicates it’s required, as it’s not a standard covered benefit.
- If you’re a Michigan health care provider, submit Blue Cross qualification forms electronically to improve form processing.
- Out-of-state providers can fax completed forms to 1-866-392-6496.
We’re instructing members to partner with their doctor to complete and submit the qualification form. We’re asking you to submit the qualification form electronically for your convenience and to help improve processing time.
The form and instructions for completing it electronically are online:
- Log in to the Provider Secured Services page at bcbsm.com.
- Scroll down to the BCBSM Qualification Form section.
- Click on the BCBSM Qualification Form link, which will send you to the online form.
- For instructions for completing the form, select BCBSM Qualification Form Instructions (located below the BCBSM Qualification Form link).
- After completing the electronic qualification form for your patient, print two copies of the form.
- Give one completed and signed copy to your patient and keep a copy of the form with the patient’s medical records.
If you’re an out-of-state provider you’ll need to fax completed forms to 1-866-392-6496. We gave your patients instructions on how to print out a form for you to complete.
Please continue using the Healthy Blue LivingSM qualification form for Blue Care Network members.
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