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STATE OF MICHIGAN MEMBER APPLICATION FOR PAYMENT CONSIDERATION Reset Medical, Vision and Hearing Benefits Complete form, print, sign and mail to: State of Michigan Service Center MC L04A THIS INFORMATION.

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All claims must be resolved with 365 calendar days from the date of service or discharge date. This applies to capitated and fee-for-service claims. Please allow for normal processing time before re-submitting a claim either through the EDI or paper process.

How to submit a claim. You'll need to fill out a claim form and mail it to us. Then we can figure out what your plan covers and how much. We'll reimburse you for charges your plan should pay.

For questions about ID cards, benefits, claims or other issues: Call the number on the back of your member ID card or 313-225-9000.

Beneficiaries with questions should contact the Beneficiary Help Line at 1-800-642-3195 (TTY: 1-866-501-5656). Providers and community partners with questions can email HealthyMichiganPlan@michigan.gov.

For additional questions, call Customer Service at 1-800-228-8554. TTY users, call 1-888-987-5832. Some services require your doctor to submit a request to Blue Cross Complete to treat your condition. This is known as an authorization.

Blue Cross Blue Shield of Michigan is proud to be the state's largest insurer, and your insurer.

Or call Customer Service 24 hours a day, seven days a week at 1-800-228-8554. TTY users should call 1-888-987-5832.

Contact your practice management or hospital information system for instructions on how to receive ERAs from Blue Cross Complete under Payer ID 32002 and the ECHO Payer ID 58379.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232