Plan Documents and Forms

Enrollment and changes

  • Join Our Network
    Find out how to join our network and gain valuable provider resources.

Non-contracted providers

Chart requests

  • Medical Record Retrieval and Review
    Learn about the medical record retrieval and review process. Ciox Health is our vendor for medical chart retrieval requests for commercial and Medicare Advantage members.

Pharmacy services

Blue Cross Blue Shield of Michigan:

Blue Care Network:

  • Custom Drug List
    Take a look at our custom drug list, also called a formulary, to find out what prescription medications are covered.
  • Custom Select Drug List
    The custom select drug list is for members with individual or small group health plans that meet the requirements of the Affordable Care Act.
  • Prior Authorization and Step Therapy Guidelines
    Learn how the Prior Authorization and Step-Therapy Guidelines can help reduce costs while maintaining quality pharmaceutical care.

Medicare Part D

Pharmacy Provider Information
Get important information about Medicare Part D.

Blue Cross Complete

Wellness plans

  • Physician Verification Form
    Use this form to request a medical waiver or update us on the progress of patients enrolled in a wellness plan.

Supply forms

  • Supply Forms
    Learn how to order general administrative materials if you're a Blue Care Network, Blue Cross Blue Shield of Michigan, dental, or vision and hearing provider.


  • Referrals
    Get access to out of network referral forms and learn how to submit referrals electronically.