For Providers: Help Center

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

Register for Web Tools

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

What's Health e-Blue?

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

How do I sign up for Electronic Data Interchange?

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

What is Provider Enrollment and Change Self-Service?

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

What is the Electronic Funds Transfer and Online Voucher Program?

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

What's Risk Bearing Contracted Entity Medical Care Group Self-Service?

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

How do I request a prescription drug prior authorization?

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

What do I need to know about specialty drugs?

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

What are the Medicare Advantage PPO and BCN Advantage drug policies and forms?

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

How do I request prescription drug coverage for a BCN Advantage member?

Learn more about medical necessity and requesting coverage for a BCN Advantage member.

PDF

Pharmacies encouraged to join the Blue Cross Vaccine Affiliation Program to facilitate COVID-19 coverage

Learn how you can sign up and use this program to ensure your patients have COVID-19 vaccine coverage.

PDF

COVID-19 testing for pharmacies for Blue Cross PPO and BCN HMO members

Read about our testing policies and how to code and bill for tests.

What do I need to know about credentialing?

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

What do I need to know about NPI?

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.

Provider Data Changes

If you're a practitioner or provider, you can use this page to find out how to make changes to your data and where to find the right forms you need.

Provider Data Attestation

If you're a practitioner or provider, follow our instructions to attest to your information.

How do I appeal a Medicare payment or claim?

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

How do I correct a Medicare Advantage overpayment?

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

How do I submit a Medicare Plus Blue PPO claim?

Follow these requirements to submit your claim correctly.

What is the Medicare Star Rating program?

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

How do I complete Medicare fraud, waste and abuse training?

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

What prior authorization requirements apply to services for Medicare Advantage members?

Learn which services require prior authorization for Medicare Advantage members.

PDF

COVID-19 testing for pharmacies for Medicare Plus Blue and BCN Advantage members

Read about our testing policies and how to code and bill for tests involving our Medicare Advantage members.

What services are covered by BCN Advantage HMO-POS for non-contracted and outside of Michigan providers?

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

What if I don't participate with Medicare?

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

What do I need to know about medical chart reviews?

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

What is Blue Cross Coordinated Care?

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