Resources for Providers

Blue Cross Complete of Michigan offers a variety of resources to its provider network.

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.
   

Michigan Quality Improvement Consortium guidelines

Visit the Michigan Quality Improvement Consortium to access the guidelines, physician tools and reports, which provide MQIC community HEDIS® and non-HEDIS results for over 100 quality improvement measures.

Telehealth resources

Visit telehealth.hhs.gov for more information on telemedicine services and resources. 

Flu prevention resources

To find helpful tips to inform and educate patients about the importance of flu shots:

Clinical and administrative resources

Clinical resources

Blue Cross Complete guidelines supersede any other applicable guidelines.

Abdominoplasty Clinical Guidelines for Coverage (PDF)
Members may receive coverage for an abdominoplasty when clinical guidelines are met. These guidelines assist in defining covered services for an abdominoplasty.

Anethesia Services for Gastrointestinal Endoscopy Guidelines for Coverage (PDF)
Members may receive coverage for anesthesia services for gastrointestinal endoscopy when clinical guidelines are met. These guidelines assist in defining covered services.

Bariatric Surgery Guidelines for Coverage (PDF)
Members may receive coverage for surgical intervention for obesity when the bariatric surgery guidelines for coverage are met.

Chronic Obstructive Pulmonary Disease (PDF)
The guidelines for COPD provide evidence-based recommendations for implementing effective disease management for patients with chronic obstructive pulmonary disease.

Orthognathic Surgery Clinical Guidelines for Coverage (PDF)
Members may receive coverage for orthognathic surgery when orthognathic surgery clinical guidelines are met. These guidelines assist in defining covered services for orthognathic surgery.

Administrative

Utilization management authorization requirements
Refer to the Utilization management authorization requirements (PDF) to learn more about benefits and services that require prior authorization.

Use the Utilization management authorization request form (PDF) to submit for prior, concurrent or retrospective review authorization requests.

Explanation of benefit codes
Refer to the Blue Cross Complete explanation of benefit codes (PDF) for new and current EOB codes.

Genetic testing codes
The Genetic Testing Codes (PDF) tells you which genetic testing codes require prior authorization.

Pharmacy reference guide
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.

Claims filing instructions
The Claims Filing Instructions Manual (PDF) guides you through submitting clean claims to Blue Cross Complete.

The Appropriate Use of Claims Modifier Guide (PDF) helps you with billing using modifier 25 and 59 appropriately.

Submitting a refund
Use the Provider Claim Refund Form (PDF) to submit a refund of overpayment to Blue Cross Complete.

Dual-eligible members
Dual-eligible members (PDF)
Learn how to serve dual-eligible members who qualify for both Medicare and Medicaid.

HEDIS handbook
The Blue Cross Complete HEDIS Supplemental Data Exchange provider handbook (PDF) provides an explanation of our data exchange processes and how we identify the necessary clinical data for closing gaps in care for our members.

Blue Cross Complete payment systems

Blue Cross Complete has implemented payment systems to meet providers’ requests for more payment options. The payment systems allow providers the ability to receive the following payment options for claims reimbursement:

Electronic funds transfer
This option allows providers to receive payments directly in the bank account of their choice. When enrolled in EFT, providers will automatically receive electronic remittance advices for those payments. To enroll in EFT, visit ECHO Healthcare to start the enrollment process.

To check the status of an EFT enrollment, contact ECHO Healthcare at 1-888-834-3511.

Virtual credit card
A virtual debit transaction in which randomly generated, temporary credit card numbers are either faxed or mailed to providers for claims reimbursement. The VCC payment notification will contain a number unique to that payment transaction and an instruction page for processing the payment.

Note: Providers who aren’t enrolled to receive EFT will automatically receive the VCC. If you don’t wish to receive your claim payments through VCC, you can opt out by calling ECHO Health at 1-888-492-5579 to receive a paper check.

Electronic remittance advice
Providers may also receive their electronic remittance advice from Change Healthcare and ECHO Health by including both the Change Healthcare Blue Cross Complete payer ID: 32002 and the ECHO Health payer ID: 58379. To receive remittance advice, visit ECHO Healthcare or contact the ECHO Health Enrollment team at 1-888-834-3511.

To access your ERAs from the Blue Cross Complete provider portal NaviNet, visit NaviNet.net.

Download the Blue Cross Complete Payment Systems (PDF) brochure for more information.

To access the ECHO Healthcare provider payments portal quick reference guide, visit ECHO Healthcare and log into your account. The User Guide can be accessed by selecting the Help button on the portal. If you require further assistance, contact your Blue Cross Complete provider account executive.

County-based contacts for providers

For more information on training, Medicaid and other topics, contact a provider account executive in your county. Select a county below for the contact details of that county's account executive.