Provider Programs

Blue Cross Complete of Michigan offers its providers a variety of programs and member benefit offerings. Each is aimed at achieving the highest level of health for our members.

Provider manuals and guides

 

Provider Manual

The Provider Manual (PDF) helps providers navigate our comprehensive network of administrative and covered services. Changes to the Provider Manual are marked with a blue dot in the manual and explained in the Blue Dot Changes Document (PDF).

 

Provider Resource Guide

The Resource Guide (PDF) provides the most commonly used contacts for Blue Cross Complete. These contacts include claims, customer service, eligibility verification and pharmacy services.

Program overviews

Mental health services are provided through the Blue Cross Complete’s mental health provider network. Eligible members can benefit from unlimited outpatient mild to moderate mental health intervention services and treatment. There are no referrals or authorizations required.

Members who have severe and persistent mental illness should contact their local PHIP in their county located at michigan.gov/mdhhs. Treatment for substance abuse disorders is not covered by Blue Cross Complete. Members must contact the substance abuse disorder coordinating agency for their county.

As a part of Blue Cross Complete’s Behavioral Health Education and Support program, we have behavioral health e-learning resources available to you.

Blue Cross Complete offers an Integrated Health Care Management, or IHCM, program that provides specialized services in comprehensive disease management and complex case management. These services focus on proactive medical care coordination, support and assistance for members with medical, behavioral and social issues affecting their quality of life and health outcomes.

Both adult and pediatric members are eligible for the program and are automatically enrolled, unless they choose to opt out.

The IHCM program is designed to help members understand their condition and achieve and maintain control of their disease. Staff work collaboratively with the member and the member’s primary care physician to promote optimal outcomes of care. Providers serving members participating in the IHCM program will receive a letter letting them know of the member’s participation in the program, along with an explanation of how we can assist in the collaborative coordination of care.

Providers can refer members for disease, case and complex case management services by calling 1-888-288-1722.

The Bright Start pregnancy management program promotes healthy behaviors and assists members in controlling risk factors during pregnancy. To refer a member to the Bright Start program, providers should call 1-888-288-1722.

Blue Cross Complete’s prescription benefits cover most generic medicines. Blue Cross Complete's Preferred Drug List (PDF) shows the medications covered by the plan, as well as medications that require prior authorization.

You can also search our online drug list to see if your patient’s medication is covered. Additional information can be found on the state of Michigan website.

Refer to the Pharmacy Reference Guide (PDF) for a quick reference about pharmacy provider services, prior authorizations, member copays, durable medical equipment covered under pharmacy and recipient restrictions.

Blue Cross Complete is a member of the Michigan managed care common formulary workgroup. As such, Current Formulary Changes (PDF) are often implemented by the state of Michigan and the workgroup.

The Tobacco Quit program is a free phone-based support program for members interested in developing a plan to quit tobacco use. It also offers ongoing support and encouragement to help members stay with the plan long-term. 

Over-the-counter agents (patches, gum and lozenges) and non-nicotine medications used to promote tobacco use cessation are included in the Blue Cross Complete’s Preferred Drug List (PDF).

For assistance, call the toll-free Tobacco Quit Line at 1-800-784-8669, 24 hours a day, seven days a week.