• Out-of-state Provider Overpayment Form (PDF)
• Plan documents and forms
• Referral forms
• Provider supply forms
• Pharmacy forms
• Blue Cross Medical Record Routing Form (PDF)

Commercial

• Acute Inpatient Fax Assessment Form (PDF)
• Acute Rehabilitation and Skilled Nursing Facility Assessment Form (PDF)
• Benefit Enhancement Assessment Form (PDF)
• LTACH and Skilled Nursing Facility Enhancement Assessment Form (PDF)

Medicare Plus Blue PPO

• Medicare Plus Blue PPO non-Michigan Skilled Nursing Facility, Acute Rehabilitation Facility Fax Assessment Form (PDF)
• Medicare Plus Blue PPO LTACH Fax Assessment Form (PDF)
• Medicare Plus Blue PPO Acute Inpatient Fax Assessment Form (PDF)