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PRACTITIONER ENROLLMENT FORM PLEASE: 1. Complete the application in its entirety. 2. No handwritten forms; please type. 3. This cover sheet must be the first page of your form submission. 4. Fax the.

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BCBSM requires prior authorization for services or procedures that may be experimental, not always medically necessary, or over utilized. Providers must submit clinical documentation in writing explaining why the proposed procedure or service is medically necessary.

The internal appeals process is as follows: You or your authorized representative must send us a written statement explaining why you disagree with our determination on your request for benefits or payment. ... We will respond to your appeal in writing within 60 days.

All claims must be submitted within 180 days of the date of service. When the required information is not included, the claim will be denied. A new claim with correct and complete information must be submitted in order for a denied claim to be reconsidered.

If you have questions regarding the completion of a transaction that is not covered within this User Guide, please call the Provider Enrollment Help Desk at 1-800-822-2761 or contact your BCBSM or BCN provider representative.

Requests for authorization for BCBS Michigan members can be submitted directly through your local Blue plans electronic portal via the Electronic Provider Access system (EPA). BCBSM encourages the use of the Electronic Provider Access system (EPA) to effectively and efficiently respond to your request.

You have 180 days from the date of discovery of a problem to file a grievance with, or appeal a decision of, Blue Cross Blue Shield of Michigan.

Some medicines require prior authorization by Blue Cross Complete. Your doctor will need to submit a prior authorization request using one of the following forms: Prior authorization online form.

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.

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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