Reminder: Only charge patients their cost share

When you treat a patient with Blue Cross Blue Shield of Michigan or Blue Care Network coverage, including our Medicare Advantage plans, Medicare Plus Blue℠ or BCN Advantage℠, be sure to bill Blue Cross or BCN for covered services and only charge the member the appropriate cost share according to their health plan coverage.

Always ask to see the patient’s health plan ID card and check their eligibility and benefits through one of these methods:

• Eligibility and Benefits Inquiry in our provider portal
• Provider Inquiry (Professional providers: 1-800-344-8525; hospital and facility providers: 1-800-249-5103)
• Electronic standard transaction

This can help you determine the appropriate member cost share, including deductible, coinsurance and copay, prior to providing the service so you can charge the member the correct amount at the time of service.

As an alternative, you can provide the service, submit the claim and wait for the remittance advice or voucher to explain the member’s cost share before billing the member. If you wait to bill the member, be sure to check that the member’s coverage is active and that the service you’re providing is a covered benefit before providing the service.

Our provider agreements prohibit participating or contracted providers from charging Blue Cross or BCN members any amounts beyond the member’s applicable cost share. If the remittance advice or voucher indicates the member’s cost share should have been less than what you charged, you’ll need to refund the member the overcharged amount.

Change to member reimbursement

Blue Cross and BCN are changing the way we manage reimbursement requests from members with Blue Cross and BCN commercial coverage. When a member sends in a request for reimbursement, we’ll look to see if the health care provider is a participating or contracted provider. If so, we’ll direct payment to the provider. The provider will then need to reimburse the member.

If your practice has been asking patients to pay for the service and request reimbursement from us, this will result in additional work for you.