Bcbs of Michigan provider phone number

Resources for Providers

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

Provider manuals and guides

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. 

Pharmacy resources

Blue Cross Complete participates in the Medicaid Health Plan Common Formulary. Under the Common Formulary, Medicaid Health Plan formulary coverage only includes products with a National Drug Code from manufacturers who participate in the Medicaid Drug Rebate Program.

• View the Medicaid Drug Rebate Program Labeler List (PDF)

Clinical and administrative resources

1. Clinical Resources
2. Administrative

Administrative

Trauma-informed care
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.

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.

Provider appeals
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 (PDF).

Care Gap Response Form Provider Guide
The Care Gap Response Form Guide (PDF) contains detailed information for providers about how to use NaviNet to enter Care Gap resolution data online. This guide explains how to retrieve and report on specific Care Gap changes.

Jiva provider portal participant guide
Use the Jiva provider portal participant guide (PDF) to learn more about using the Jiva provider portal.

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.

Blood pressure cuffs
Refer to the MDHHS coverage of automated home blood pressure cuffs (PDF) for Medicaid managed care plan benefit and authorization details.

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.

Condition Optimization Program Provider User Guide
The Condition Optimization Program Provider User Guide (PDF) contains details about how providers access Condition Optimization Program workflow activities within NaviNet.

“Connecting our members to premier ancillary services and specialists” Program Guide
The COMPASS Program Guide (PDF) 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).

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
Electronic funds transfers allow you to receive your payments directly in the bank account you designate rather than receiving them by virtual credit card or paper check. When enrolling in EFT, you will automatically receive electronic remittance advices for those payments. All generated ERAs and a detailed explanation of payment for each transaction will also be accessible for download from the ECHO provider portal at providerpayments.com.  

To sign-up to receive EFT from Blue Cross Complete, visit ECHO Healthcare.    

To check the status of an EFT enrollment or obtain technical support, contact ECHO customer service at or call  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.

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.

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