Self-Service Tools

Blue Cross Complete of Michigan's self-service tools are valuable resources that can assist you in providing the highest quality of care to our members.

Drug formulary

A comprehensive drug list for Blue Cross Complete can be accessed and reviewed in two ways:

The searchable version of the drug list provides additional details regarding quantity limits, prior authorizations or other coverage details not available on the printable version. This includes guidance for obtaining specialty medications.

For pharmacies

The PerformRx Pricing Administration Department calculates generic Maximum Allowable Cost and money paid to participating pharmacies. MAC prices are updated each week. To ask for a MAC pricing review, email the PerformRx Pricing Administration Department. You can also call PerformRx Pharmacy Provider Services at 1-888-989-0057.

Prior Authorization Lookup

Find out if a service needs prior authorization. Type a Current Procedural Terminology, or CPT, code or a Healthcare Common Procedure Coding System, or HCPCS, code in the space below to get started.

Directions

1. Enter a CPT or HCPCS code in the space below.
2. Click Submit.
3. The tool will tell you if that service needs prior authorization.

Important notice

This tool provides general information for outpatient services performed by a participating provider.

The following services always require prior authorization:

• Elective inpatient services
• Urgent inpatient services

The results of this tool aren’t a guarantee of coverage or authorization. All results are subject to change in accordance with plan policies and procedures and the Provider Manual (PDF).

If you have questions about this tool or a service or to request a prior authorization, call Blue Cross Complete's Provider Inquiry at 1-888-312-5713.

Healthcare common procedure coding system medications 

A prior authorization for healthcare common procedure coding system medications is required before they are covered by Blue Cross Complete. Click the HCPCS PA List (PDF) for a list of codes that require prior authorization.

Prior authorization

Some medicines and benefits require prior authorization by Blue Cross Complete. Submit a prior authorization request using one of the following forms:

• Medication prior authorization online form
• Medication prior authorization request form (PDF)

You must submit a request for a prior authorization for your patient. You must also submit an override of a drug restriction. Request from pharmacies aren't accepted.  

Pharmacy billing

The electronic processing of retail pharmacy claims requires a NCPDP processor ID number, also known as a BIN, and a processor control number, or a PCN, for plan identification. Blue Cross Complete's D.0 Payer Sheet (PDF) contains our BIN (600428), PCN (06210000), member services number, field definitions and other helpful information for pharmacy claim billing and rebilling.

NaviNet

By logging on to the Blue Cross Complete payer-provider portal Navinet, you have the opportunity to:

• Receive news alerts in real time
• View Blue Cross Complete member information
• Submit authorization requests
• View gaps in care reports 
• Check the status of claims

Visit NaviNet Basics if you have not yet enrolled or would like more information.