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January 2020

Provider Enrollment may request new signature document for Association audit

A Provider Enrollment technician may reach out to your office via email, fax or phone to request a new, signed signature document. This is simply a request to fulfill a Blue Cross and Blue Shield Association audit. Your current relationship with Blue Cross won’t be affected in any way from this request.

To successfully fulfill this request, it’s important that the new signature document is completed and sent back to the Provider Enrollment and Data Management representative who made the request.

If you have questions, contact Provider Enrollment at 1-800-822-2761.

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 2019 American Medical Association. All rights reserved.