We are simplifying inquiry and appeal process

As part of our efforts to streamline processes and improve your overall experience with Blue Cross Blue Shield of Michigan, we’ll begin accepting your claim appeal verbally when you contact Provider Relations & Servicing, effective Oct. 1, 2020.   

You should continue to contact PRS at one of the telephone numbers listed below for any inquiry related to benefits, eligibility and claims. Beginning in October, if you’re not satisfied with the inquiry outcome about a claim determination, you may request an appeal while speaking with a Customer Service representative.

If you have additional information to include with your appeal, the representative will provide you with a number to fax your supporting documentation. A written response will be issued to you within 30 days of receipt of your documentation.

• Medical providers: 1-800-344-8525
• Vision and hearing providers: 1-800-482-4047
• Facility providers: 1-800-249-5103

Beginning Oct. 1, you won’t be able to submit a written appeal to Blue Cross Blue Shield of Michigan at Mail Code 1620 or fax it to 1-877-348-2210.

As a reminder, you may be eligible for a claim appeal when the following criteria are met:

• The member is enrolled in a Blue Cross commercial plan.
• The rendering provider is one of the following:
• A Blue Cross Blue Shield of Michigan participating provider located in Michigan
• An out-of-state provider who participates with Blue Cross Blue Shield of Michigan and has a Michigan PIN
• A nonparticipating provider located in Michigan who has accepted assignment on the claim, on a per claim basis
• The appeal is for a professional claim that was filed within 180 days from the date of service, or a facility claim that was filed within 365 days from the date of service.
• The appeal request is made within 180 days from the date of the original claim determination.
• The supporting documentation is submitted within 30 days of contacting PRS.
• A request for appeal wasn’t submitted previously on the same claim.

Reminders:

• If you received a nonpayment notice indicating a billing error, submit a new claim that includes the requested information.
• If your claim is denied for lack of authorization, request a retro-authorization within the allowed time frame. Reach out to the appropriate authorization team or vendor to initiate the review.