For Providers: 30-Day Open Negotiation Period and Independent Dispute Resolution

If your voucher indicated that your claim was processed under the surprise billing laws, you may only collect the subscriber liability from your patient. If you billed accept assignment on the claim, the allowed amount represents the amount you agreed to accept for this service. If you didn't bill accept assignment on the claim, the allowed amount is the qualifying payment amount which was calculated based on federal law or the amount calculated under the Michigan surprise billing law.

If you didn't bill accept assignment on the claim and you have a reason to believe the allowed amount is incorrect, you have 30 business days from the date of payment to initiate the federal 30-day open negotiation period. If you choose to initiate the open negotiation period, fill out the federal Open Negotiation Notice form. Submit the form to:

Blue Cross Blue Shield of Michigan
Federal Surprise Billing Dispute Imaging and Support Services
P.O. Box 44405
Detroit, MI  48233-9998

In addition to the open negotiation form, you’ll need to submit the Additional claim information required from nonparticipating health care providers for open negotiations form. This form will provide more information specific to the claim.

If the open negotiation doesn't resolve your issue, you may access the Independent Dispute Resolution process, or IDR, within four business days of the close of the open negotiation period. To begin this process, fill out the federal Notice of IDR Initiation form.

 

Federal Notice and Consent

Under the surprise billing legislation, nonparticipating providers can obtain legal consent to balance bill their patient using the standard notice and consent documents developed by the Department of Health and Human Services. Visit cms.gov to access the standard notice and consent documents under the No Surprises Act. Scroll down to see the Surprise Billing Protection Form. This process isn't available for emergency services or for non-emergency services provided by ancillary providers in participating facilities.

These documents can be used when providing items and services to participants, beneficiaries, enrollees or covered individuals in group health plans or group or individual health insurance coverage, including health plans for federal employees, by either:

  • A nonparticipating provider or nonparticipating emergency facility when providing certain non-emergency post-stabilization services, or
  • A nonparticipating provider or facility on behalf of the provider when providing non-emergency services at participating health care facilities. This doesn't apply to ancillary services identified in the No Surprises Act such as anesthesia, radiology or other services where the patient does not generally choose the provider. 

Visit cms.gov for more detailed information on when a provider can use the notice and consent process.

If you used the federal notice and consent process that allows balance billing in certain scenarios, you’ll need to submit the Additional claim information required from nonparticipating health care providers for exemptions from surprise billing form. This additional form will provide more information specific to the claim. Submit it to: 

Blue Cross Blue Shield of Michigan
Federal Surprise Billing Dispute Imaging and Support Services
P.O. Box 44405
Detroit, MI  48233-9998

If you meet the criteria to balance bill your patient, Blue Cross will reprocess your claim as a non-surprise bill.

For more information on surprise billing, see the January 2022 edition of The Record.