Call Provider Inquiry to initiate Level 1 appeal according to the claim inquiry and appeal process in the provider manual for commercial PPO

Blue Cross Blue Shield of Michigan has updated the filing guidelines for submitting post service, commercial PPO claim appeals. We’ve updated the provider Level 1 appeal process in the Blue Cross Commercial Provider Manual with the new information. There is no change to how Level 1 appeals are handled and reviewed.

How to file an appeal

To submit a post service claim appeal, health care providers must first contact Provider Inquiry by phone. If you choose to request to an appeal during the phone call, and you have additional documentation to be reviewed, we’ll fax or mail you a Provider Level 1 Appeal Fax Cover Sheet, if you meet eligibility criteria. 

Post service claim appeals must be received with the Provider Level 1 Appeal Fax Cover Sheet from Provider Inquiry or on the provider’s office letterhead. If you submit an appeal on office letterhead, you must include the reference number, date and time of your call to Provider Inquiry and the representative’s name. The appeal will be considered ineligible if you use any other cover sheets or appeal forms. You won’t be eligible to make further attempts to appeal the claim.

The filing guidelines under the Appeals and Problem Resolution chapter of the provider manual has been updated with this information.