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  • Blue Cross Blue Shield Of Michigan Legacy Medigap Application Form

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Application for Legacy Medigap Coverage Print in black or blue ink, or type your information and complete all sections as indicated. Review your application for completeness and accuracy, and sign.

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For processing efficiency and cost savings to the providers, Michigan Complete Health encourages its providers to file claims electronically. The Payor ID is 68069.

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.

please call 1-877-469-2583. When you write to us, please include the following: The group and contract numbers on your subscriber ID card, also known as enrollee ID. Your daytime phone number, including your area code.

Blue Cross Complete's D. 0 Payer Sheet (PDF) contains Blue Cross Complete's BIN (600428), PCN (06210000), member services number, field definitions and other helpful information for pharmacy claim billing and rebilling.

Blue Cross and Blue Shield of Michigan, 600 E Lafayette Blvd, Detroit, MI, Insurance Group - MapQuest.

Submit completed forms and requests to Provider Network Operations at: bccproviderdata@mibluecrosscomplete.com or fax to 1-855-306-9762. Provider Secured Services at mibluecrosscomplete.com or by logging in directly at navinet.navimedix.com.

Find out how to make a payment. 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.

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© Copyright 1997-2025
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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
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
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