Claims Questions and Appeals

If you have a question about payment you received for services provided to a Medicare Plus Blue℠ PPO or Blue Cross® Medicare Private Fee for Service member, contact the plan that issued the check (usually your local Blue plan).

You may appeal a denial or a payment amount if you believe the same service would have been covered, or covered at a higher payment amount, under Medicare.

For Medicare Plus Blue PPO, refer to the Medicare Plus Blue PPO manual (PDF) for more information.

For Blue Cross® Medicare PFFS, refer to the Blue Cross® Medicare Private Fee for Service manual (PDF)

For questions about Medicare Plus Blue PPO or Blue Cross® Medicare PFFS dental claims, please call 1-888-826-8152.

Pharmacies with questions about AWP or MAC pricing should contact BCBSM's Technical Pharmacy Help Desk at 1-800-437-3803.

For clinical editing appeals for Medicare Plus Blue PPO or to find out how the appeal process works, refer to the following documents: