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Get MI BCBS E-Referral Application Form 2006

Mail: Current web-DENIS ID for physician group: Please list the provider codes for the physicians/facility requesting e-referral access: Provider/facility name BCBSM Individual PIN number Fax both pages of the completed application to the BCN Provider Affairs office in your area: East region Mid region 810-720-8627 989-249-3791 517-322-8086 Flint Saginaw Lansing Southeast region West region 248-455-3476 616-956-5774 Southfield Grand Rapids Portage Traverse City e referral Applica.

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