For Providers: What if I Don't Participate with Medicare?

Providers must participate with Medicare in order to join the Medicare Advantage PPO network, unless the provider's specialty is exempt from participation in Medicare by CMS. Information about network participation and affiliation is available in the Medicare Plus Blue PPO Manual (PDF).

What is the limiting charge?

For providers who have not contracted with Medicare or BCBSM's Medicare Advantage PPO network, the limiting charge applies to certain provider types for specific billing situations. More information about Medicare's limiting charge can be accessed in Chapter 4 of the Medicare Managed Care Manual (PDF).

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Documents and forms for non-contracted or outside Michigan providers

Medicare Plus Blue℠ PPO fact sheet (PDF)
Acute inpatient hospital assessment form (PDF) – Blue Cross and BCN commercial
Prior authorization requirements for Michigan and Non-Michigan providers for Blue Cross commercial and Medicare Plus Blue℠ (PDF)
Waiver of Liability (ZIP)
Advantasure® Remote Clinical Documentation Improvement Program™ (PDF)
Clinical Documentation Improvement Welcome letter (PDF)
Clinical Documentation Improvement Alert sample (PDF)
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