Administrative Resources

Providers can submit appeals related to an adverse action of a post service request, including service denials, delays or limitations. The appeal must be submitted with documentation to support medical necessity or appropriateness. For more information, refer to the Provider Appeals section of the Provider Manual.

To improve mental health treatment for members, Blue Cross Complete follows The National Council for Wellbeing’s guideline for trauma-informed primary care – Fostering Resilience and Recovery: A Change Package for Advancing Trauma-Informed Primary Care. Implementing trauma-informed approaches marks a fundamental shift in care delivery that supports improved utilization of services, improved patient outcomes, increased staff satisfaction and healthier work environments.

The “Connecting our members to premier ancillary services and specialists” Program Guide
contains detailed information about the COMPASS program (including a complete list of episode category descriptions, the opt-out process, and how to appeal program determinations).

Independent laboratory drug testing payment provides information about payment for medically necessary presumptive and definitive drug testing for independence.

The Michigan Department of Health and Human Services Blood Lead Testing resources provide information on blood lead testing.

Michigan Department of Health and Human Services Blood Pressure Cuffs provides information on Medicaid managed care plan benefit and authorization details for blood pressure cuffs.

Neuropsychological testing guidelines provides clarification on conditions in which Blue Cross Complete covers neuropsychological testing.

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

The Claims Filing Instructions Manual guides you through submitting clean claims to Blue Cross Complete.

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

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

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