You'll need to follow all the billing guidelines detailed in the Medicare Claims Processing Manual.
If you're submitting a claim electronically use ASC X12 837.
Professional services using paper claims should use a CMS-1500 form.
Facilities and institutions submitting paper claims should fill out a CMS-1450, also known as UB-04, form.
Some services require a Certificate of Medical Necessity, a durable medical equipment information form, a prescription or other documentation with the first-month supply claim, a first-month rental equipment claim, or a claim for a one-time equipment purchase. We will deny claims that require, but do not include, appropriate documentation. The required forms can be found on the CMS Forms List.
Unique billing requirements
In order to submit Medicare Plus Blue PPO claims, you must complete a provider authorization and register your national provider identifier with us. Use Medicare B DMERC as the source of payment when completing the provider authorization.
Follow these billing requirements:
- For professionals: Blue Cross Blue Shield of Michigan HIPAA Transaction Standard Companion Guide - 837 Professional (PDF)
- For institutions: Blue Cross Blue Shield of Michigan HIPAA Transaction Standard Companion Guide - 837 Institutional (PDF)
- For billing electronic claims for HCPCS codes with local carrier jurisdiction: Contact your local Blue Cross plan or its EDI administrator for billing instructions.
- For ancillary claims: Bill to your local Blue Cross plan. Follow these instructions for specific ancillary claims:
- Independent labs: File claims with the plan in the state where the specimen was drawn (determined by where the referring physician is located).
- Durable medical equipment suppliers: File claims with the plan in the state where the equipment or supplies were shipped to (including mail order supplies) or purchased (if they were purchased at a retail store).
- Specialty pharmacies: File claims with the plan in the state where the ordering physician is located.
- For enhanced benefits: Verify coverage for a specific member by calling Provider Inquiry at 1-866-309-1719. Reference our Enhanced Benefit Policy Papers for specific billing requirements for enhanced benefits. Not all enhanced benefits are covered by all Medicare Plus Blue individual or group plans.
More information about submitting claims
- Submit claims within one calendar year of the date of service or we cannot pay for the service.
- You cannot charge a patient if you did not submit the claim to us.
- Blue Cross Blue Shield of Michigan or your local Blue Cross plan will send you the remittance advice.
- Blue Cross Blue Shield of Michigan or your local Blue Cross plan will reimburse you.