Fee schedule for outside Michigan and non-contracted providers in Michigan

The Medicare Plus Blue PPO BCBSM Medicare Advantage Fee Schedule's maximum payment levels are consistent with Original Medicare. ESRD facilities should refer to the Medicare Advantage ESRD fee schedule (PDF), also found under Facility Fee Schedules. Member copayments and deductibles apply.

For information about reimbursement of enhanced benefits, refer to the enhanced benefits fee schedule (PDF).

We reimburse out-of-network claims using the CMS fee schedule. Member copayments and deductibles apply.

When can you expect payment?

We process and pay clean claims within 30 days of receipt. If a clean claim is not paid within the 30-day time frame, we will pay interest in accordance with CMS regulations and the Medicare Advantage Provider Agreement.

Reimbursement for dental providers

Some Medicare Plus Blue PPO plans provide coverage for routine dental procedures as an enhanced benefit. These procedures are typically performed and billed by general dentists.

Refer to your Blue Dental Provider Manual for more information.

Out-of-network reimbursement for DME/P&O, medical supplies and pharmacists

We reimburse out-of-network claims for Medicare Plus Blue PPO members using the CMS fee schedule with a higher level of member cost sharing applied.

Medical Chart Reimbursement

When a medical chart retrieval vendor asks for your medical charts, providers can ask for reimbursement. 
  • Ciox Health performs risk adjustment retrievals for Medicare Advantage members. You can request reimbursement as a facility or a provider by submitting this form (PDF). Read about our process in our frequently asked questions (PDF) for Ciox Health. 
  • A Blue Cross HEDIS clinical consultant performs HEDIS retrievals from February through May for Blue Cross PPO and Medicare Advantage members. You may receive reimbursement for returned medical records by submitting the reimbursement form (PDF) or through your HEDIS clinical consultant.