Reminder: Independent labs must provide advance notice to Blue Cross commercial members before providing noncovered services

Here’s information you need to know about providing noncovered services to Blue Cross Blue Shield of Michigan commercial members at outpatient laboratories.

Independent laboratories

Before receiving noncovered services at independent laboratories, Blue Cross commercial members must sign the Advance Notice of Member Responsibility form.

Prior to having members sign the form, be sure to familiarize yourself with the requirements under our Clinical Laboratory Agreement.

The language in this agreement states that independent laboratories may bill members for services that Blue Cross has deemed to be not medically necessary only when all of the following are true:

• Each member must specifically agree to these conditions in advance:
• The member acknowledges that Blue Cross won’t pay for specific services because they were deemed medically unnecessary.
• The member consents to receiving the services before the services are provided.
• The member assumes financial responsibility for the services.
• The health care provider provides the member with an estimated cost for the services.
• Each form must state that Blue Cross won’t pay for the specific services and must include a price estimate for each service.

To access the Advance Notice of Member Responsibility form: 

1. Log in to our provider portal (availity.com).**
2. Click on Payer Spaces in the menu, then click on the BCBSM and BCN logo.
3. Click on the Resources tab.
4. Click on the Secure Provider Resources (Blue Cross and BCN) link.
5. On the Provider Resources site, click on Forms in the menu, then on click Prior Authorization.
6. Click on the Advance Notice of Member Responsibility for GY or GZ modifiers (PDF) link.

Hospital laboratories

The Advance Notice of Member Responsibility form isn’t approved for use by hospital labs at this time. We’re currently reviewing the processes for hospital labs. Watch for an upcoming provider alert and Record article with more information.

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

**Blue Cross Blue Shield of Michigan doesn’t own or control this website.