General Inquiries313-225-9000 Show
Blue Cross Blue Shield of Michigan Field Service Mental Health/Substance Use Disorder Precertification800-342-5891
Care Management ProgramsAsthma Chronic Obstructive Pulmonary Disease If you are deaf, hard of hearing, or have a speech disability, dial 711 for TTY relay services. For other language assistance or translation services, please call the customer service number for your local Blue Cross and Blue Shield company. We're here to answer your questions about your benefits, services and medical needs. Blue Cross CompleteBlue Cross Complete of Michigan Helpful phone numbers
Services & benefitsCustomer ServicePharmacy Customer ServiceDental Customer ServiceHealthy Kids DentalUrgent medical needsRapid Response Outreach Team24-hour Nurse Help LineOther numbersAnti-Fraud Hotline1-855-232-7640 Privacy Practices1-800-228-8554 Durable Medical EquipmentOutpatient Lab ServicesJoint Venture Hospital Laboratories Tobacco Quit ProgramDiabetic SuppliesBlue 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. Provider directoriesDrug formularyA 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 pharmaciesThe 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 LookupFind 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
Important noticeThis tool provides general information for outpatient services performed by a participating provider. The following services always require prior authorization:
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 medicationsA 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 authorizationSome medicines and benefits require prior authorization by Blue Cross Complete. Submit a prior authorization request using one of the following forms:
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 billingThe 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. NaviNetBy logging on to the Blue Cross Complete payer-provider portal Navinet, you have the opportunity to:
Visit NaviNet Basics if you have not yet enrolled or would like more information. |
Blue cross blue shield michigan prior authorization phone number
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