Direct reimbursement available to clinical nurse specialists, beginning Jan. 1

Clinical nurse specialists will have the opportunity to participate in Blue Cross Blue Shield of Michigan’s Traditional and TRUST PPO networks and Medicare Plus Blue^SM, as well as the Blue Care Network HMO and BCN Advantage^SM, starting Jan. 1, 2020.

Participating clinical nurse specialists will receive direct reimbursement for covered services within the scope of their licensure at 85% of the applicable fee schedule, minus any member deductibles and copayments. This change affects Blue Cross and BCN benefit plans that cover services that clinical nurse specialists are licensed to provide. To find out if a patient has coverage, check web-DENIS for member benefits and eligibility or call Provider Inquiry at 1-800-344-8525.

Starting in October, clinical nurse specialists can find enrollment forms and practitioner agreements on bcbsm.com. To find enrollment information, click on Providers and then on Join Our Network. Specific qualification requirements are identified within each agreement.

All applicants to the TRUST PPO, Medicare Plus Blue, BCN HMO and BCN Advantage networks must pass a credentialing review before participation. We’ll notify applicants in writing of their approval status.

For more information, contact Provider Inquiry or your provider consultant.