For Providers: Help Center

Find the answers you're looking for. Choose a topic to get started.

Enrollment

Find out what's involved in credentialing when you want to join our network and learn how to recredential when necessary.

National Provider Identifier, or NPI, is a provider's 10-digit unique identifier that represents them in HIPAA standard transactions. Learn more about why it's important.

Care management

Learn why we sometimes require medical chart reviews and how you can get reimbursed for them.

Learn more about Blue Cross Coordinated Care, a care management program designed to help qualified patients with BCBSM coverage.

Blue Cross Blue Shield providers in Michigan, learn about Healthy Blue Achieve, a wellness PPO plan to lower costs for patients committed to healthy lifestyles.

Medicare Advantage

Learn your rights as a provider to appeal decisions about Medicare claims and payments.

If you've received a Medicare Advantage overpayment, learn how it will be corrected.

Follow these requirements to submit your claim correctly.

The Centers for Medicare & Medicaid Services issue star ratings for Medicare Advantage plans each year. Learn why this program matters to providers.

If you're serving our Medicare Advantage members, you must complete fraud, waste and abuse training. Learn how.

Learn more about the services that are covered for providers who are non-contract or outside of Michigan.

Learn about medical necessity and requesting coverage for a BCNA member.

Learn our medical policies for our Medicare products to avoid a rejected claim.

Find information for providers who don't participate with Medicare or who are outside of Michigan.

Pharmacy services

We sometimes require providers to take additional steps before certain drugs are covered.

Learn what specialty drugs are, how to bill for them and what limitations we have on certain medications.

Provider portal tools

Learn how to register for provider tools, add members to your account or edit access for existing members.

Web-DENIS is our online information system for providers within the secured provider portal. You can use it to look up patient eligibility, copays and other information.

Learn about Health e-Blue, a way to track and share information about patient health.

Learn how to sign up for Electronic Data Interchange, or EDI, to exchange information like claims, electronic enrollment and patient eligibility.

With this application, group administrators can update their information with us and enroll new practitioners within their group.

Interested in the EFT and online vouchers program? Learn who is eligible and how to register.

Learn more about Risk Bearing Contracted Entity Medical Care Group Self-Service and how it can keep transactions secure and up-to-date.