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April 2023

Reminder: Double-check Blue Cross commercial members’ coverage for COVID-19 vaccines

Some Blue Cross Blue Shield of Michigan commercial members have group plans that are exempt from complying with Affordable Care Act requirements. During much of the public health emergency, we covered 100% of the costs for administering COVID-19 vaccines to these members.

Effective April 1, 2023, these members will revert to their pre-pandemic vaccine coverage, unless their group requested otherwise. As a result, they may have out-of-pocket costs or may not have vaccine coverage.

Health care providers should check each Blue Cross commercial member’s eligibility and benefits to determine whether COVID-19 vaccines are a covered benefit.

Notes:

  • When the public health emergency ends May 12, all Blue Cross and BCN members will continue to have COVID-19 vaccine coverage with no out-of-pocket costs if they meet the following criteria:
    • Their plans comply with ACA requirements.
    • Their vaccines are administered by in-network providers or at in‑network pharmacies.
  • When the government-purchased supply of the COVID-19 vaccines runs out, providers should bill the member’s health plan for both administration and the vaccine product. We’ll process claims based on members’ immunization benefits.

Here’s how to check member eligibility and benefits for vaccines:

  1. Log in to our provider portal (availity.com).**
  2. Click on Patient Registration in the menu bar, then click on Eligibility and Benefits Inquiry.
  3. Enter the necessary information in the Payer section and the Provider Information section.
  4. In the Service Information section, enter Immunizations in the Benefit / Service Type field.
  5. Enter the patient ID in the Patient Information section.
  6. Click on Search.
  7. Select the tile for the appropriate member, and click on Submit.
  8. Do one of the following:

If…

Then…

There is a Benefit Explainer button near the top of the screen.
  1. Click on the Benefit Explainer button.

    2. Note: If Benefit Explainer doesn’t open, you’ll need to allow Availity® to open popups.

  2. In Benefit Explainer, click on the Search button.
  3. Press the CTRL and F keys.
  4. Search on Preventive Immunizations.

There isn’t a Benefit Explainer button near the top of the screen.
  1. Click on the Coverage and Benefits tab.
  2. Look in the Immunizations sections.

Availity is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to offer provider portal services.

**Blue Cross Blue Shield of Michigan and Blue Care Network don’t own or control this website.

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 2022 American Medical Association. All rights reserved.
Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and
independent licensees of the Blue Cross and Blue Shield Association.