Forms for Providers
Helpful forms
Enrollment forms
Are you interested in participating with Blue Cross Complete of Michigan? If so, complete the appropriate form below:
Change forms
If you are already enrolled but need to change things such as provider name, contact information, office hours, panel status, or hospital affiliations, please fill out the Provider Change Form.
Where to submit forms
Submit forms using one of the following contact methods:
Blue Cross Complete of Michigan
Attention: Provider Network Operations
4000 Town Center, Suite 1300
Southfield, MI 48075
Email: bccproviderdata@mibluecrosscomplete.com
Fax: 1-855-306-9762
Blood lead test forms
Other MDHHS forms
Contact MDHHS
Michigan Department of Health & Human Services
333 S. Grand Ave
P.O. Box 30195
Lansing, Michigan 48909
Enrollment forms
Are you interested in participating with Blue Cross Complete of Michigan? If so, complete the appropriate form below:
Change forms
If you are already enrolled but need to change things such as provider name, contact information, office hours, panel status, or hospital affiliations, please fill out the Provider Change Form.
Where to submit forms
Submit forms using one of the following contact methods:
Blue Cross Complete of Michigan
Attention: Provider Network Operations
4000 Town Center, Suite 1300
Southfield, MI 48075
Email: bccproviderdata@mibluecrosscomplete.com
Fax: 1-855-306-9762
Blood lead test forms
Other MDHHS forms
Contact MDHHS
Michigan Department of Health & Human Services
333 S. Grand Ave
P.O. Box 30195
Lansing, Michigan 48909