Changes to Michigan’s auto no-fault insurance law may increase need for coordination of benefits

Effective with auto insurance policies issued or renewed after July 1, 2020, individuals will no longer be required to carry unlimited personal injury protection, or PIP, with their auto insurance. Under certain circumstances, drivers can select different levels — or opt out — of PIP coverage through their auto insurer.

In situations where a member’s auto insurance is considered primary to their Blue Cross Blue Shield of Michigan coverage — and they select a level of PIP coverage that’s less than unlimited — their auto insurance benefits may run out. These changes to Michigan’s auto no-fault insurance law may lead to more instances where providers need to coordinate benefits for their patients.

More of what you need to know

• Continue to bill auto accidents as you do today.
• Enter the appropriate value indicating an auto-accident claim.
• Continue to follow existing Medicare guidelines pertaining to billing and secondary payer rules.
• PIP is a “lifetime per accident per patient” benefit, not an “annual per family or per individual” maximum.
• PIP coverage pays for some items that health insurance doesn’t, such as attendant care, lost wages and vehicle or housing modifications. (PIP also pays for services that Medicare coverage may not, such as transportation to and from medical appointments and vehicle modifications.)
• If the auto insurer is considered the primary payer, Blue Cross will reject the claim if we’re billed as primary payer.
• When the member’s auto PIP benefits are exhausted, you’ll receive a rejection from the auto insurer. (PR*119 or PR*149 may be indicated on the 835 denial.) You can then bill Blue Cross, indicating Blue Cross is secondary.
• When you bill Blue Cross as a secondary payer, you’ll need to include the primary auto insurer name along with the primary auto insurance claim decision resolution (value code) on the 837.

Determining which insurance is primary

Provider should ask members:

• Do you have coverage from more than one insurance carrier?
• Is your injury the result of an accident?
• Does your medical coverage have any restrictions, such as not paying for claims related to an auto accident or paying secondary only?

Note: In most cases, Blue Cross is the primary payer and health care providers will continue to bill Blue Cross first.

If you need more information about how Blue Cross coordinates auto insurance benefits, refer to the Blue Cross PPO (Commercial) Provider Manual by logging in to Provider Secured Services. Refer to the auto insurance section of the Coordination of Benefits chapter.

If you have questions about coordinating benefits with a member’s existing auto insurer, call Provider Inquiry. Professional providers can call Provider Inquiry at 1-800-344-8525 and hospital and other facility providers can call 1-800-249-5103.