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DME, Medical Supplies and P & OBehavioral HealthBenefits and EligibilityClaimsCoordination of BenefitsCustomer ServiceDME, Medical Suppliesand P & OHealth & WellnessFor outpatient durablemedical equipment,medical suppliesand prosthetics andorthotics, BCN contractswith different vendors,depending on themember’s plan or productand the type of item.Refer to the informationon this page to identify theappropriate vendor.Laboratory ServicesMusculolskeletal ServicesPharmacy ServicesPT, OT and STProvider Enrollment andChange RequestsProvider InquiryProvider OutreachQuality / Population HealthDiabetic supplies(not including diabeticshoes and inserts)DME and P&O(including diabetic shoesand inserts)VendorJ&B Medical SupplyVendorNorthwood, Inc.TelephoneVoice: 1-888-896-6233TTY: 1-800-737-0084TelephoneVoice: 1-800-393-6432TTY: ness hoursMonday – Friday8 a.m. to 5 p.m.Business hoursMonday – Friday8:30 a.m. to 5 p.m.Mailing addressJ&B Medical, Inc.50496 West Pontiac TrailWixom, MI 48393Mailing addressNorthwood, Inc.7277 BerniceCenter Line, MI 48015WebVisit jandbmedical.com.WebVisit northwoodinc.com.Blue CrossCompleteFor Blue Cross Completevendor contact information,see the Blue CrossComplete Provider Manualat MiBlueCrossComplete.com/providersNote: Call Northwoodto identify a contractedsupplier. The suppliersubmits the request toNorthwood for review.Travel ServicesUtilization Managementbcbsm.com ereferrals.bcbsm.comBCN HMO (commercial)and BCN AdvantageJune 1, 2018PreviousHomeNext

Health & WellnessBehavioral HealthBenefits and EligibilityClaimsCoordination of BenefitsCustomer ServiceDME, Medical Suppliesand P & OHealth & WellnessLaboratory ServicesMusculolskeletal ServicesPharmacy ServicesPT, OT and STProvider Enrollment andChange RequestsProvider InquiryProvider OutreachQuality / Population HealthHealthy living informationthrough Blue Cross Health& WellnessBCN Chronic Condition Management departmentThe Blue Cross Health & Wellnessprogram, powered by WebMD , isavailable 24 hours a day, every day,through bcbsm.com.Business hoursMonday – Friday (except holidays), 8:30 a.m. to 5 p.m.This online service offers informationon health and wellness as well ashelpful online tools and resources.Through Blue Cross Health &Wellness, members can use thefollowing resources: Health assessmentDigital Health AssistantWebMD Health RecordMessagingWebMD Weigh TodaySMDevice and app integrationHealth trackersWebMD message boardexchange WebMD tobacco cessationcoachingTelephone1-800-392-4247WebVisit bcbsm.com Health and Wellness (under For Members) Learn More(under Chronic condition management) Chronic condition managementprograms (under Blue Care Network).Mailing addressBCN Chronic Condition ManagementMail Code C336P.O. Box 5043Southfield, MI 48086-5043Travel ServicesUtilization Managementbcbsm.com ereferrals.bcbsm.comNovember 2016PreviousHomeNext

Laboratory ServicesBehavioral HealthBenefits and EligibilityClaimsCoordination of BenefitsCustomer ServiceDME, Medical Suppliesand P & OHealth & WellnessLaboratory ServicesMusculolskeletal ServicesPharmacy ServicesContact Joint Venture Hospital Laboratories,BCN’s contracted provider for outpatient laboratoryservices, for the following:Note: This applies to outpatient laboratory servicesin locations other than physician offices. To locate a client service center nearest youTo inquire about billingTo obtain test resultsTo request materialsNote on facility claims: The following are payable byBCN: ER laboratory services Laboratory services for observation stays,when submitted on the observation claim.(Note: This does not apply to BCN usiness HoursMonday – Friday (except holidays), 8 a.m. to 4:30 p.m.Mailing addressJVHL999 Republic Drive, Suite 300Allen Park, MI 48101WebVisit Joint Venture Hospital Laboratories at jvhl.org.PT, OT and STProvider Enrollment andChange RequestsProvider InquiryProvider OutreachQuality / Population HealthTravel ServicesUtilization Managementbcbsm.com ereferrals.bcbsm.comApril 2016PreviousHomeNext

Musculoskeletal ServicesBehavioral HealthBenefits and EligibilityClaimsCoordination of BenefitsCustomer ServiceDME, Medical Suppliesand P & OHealth & WellnessLaboratory ServicesMusculolskeletal ServicesPharmacy ServicesPT, OT and STProvider Enrollment andChange RequestsProvider InquiryProvider OutreachTurningPoint HealthcareSolutions, LLC, managesauthorizations for certainmusculoskeletal surgical andother related procedures forBCN HMO and BCN Advantagemembers. These include:For dates of service on or afterJuly 1, 2020: Knee arthroscopy Cervical and lumber spinesurgery Joint replacement (knee, hip,shoulder) Spinal cord stimulator(neurostimulator) Epidural or intrathecal catheter Other musculoskeletalproceduresFor dates of service on or afterJan. 1, 2021: Pain managementQuality / Population HealthWebFor information on how to submit prior authorizationrequests to TurningPoint, refer to the documentMusculoskeletal procedure authorizations: Frequently askedquestions for providers.Note: Look at the question “Should I submit authorizationrequests directly to TurningPoint?”For a list of the procedure codes associated with theservices that require review by TurningPoint, refer to thedocument Musculoskeletal procedure codes that requireauthorization by TurningPoint.This list shows where to submit authorization requests fordates of service that occurred before TurningPoint beganmanaging the authorizations for those services.For more information, visit ereferrals.bcbsm.com BCN Musculoskeletal Services.Business hoursMonday – Friday, 8 a.m. to 8 p.m., Eastern timeContact informationProvider Relations Support Team Email: BCBSMProviderRelations@tpshealth.com Phone: 313-908-6041Travel ServicesUtilization Managementbcbsm.com ereferrals.bcbsm.comOctober 2020PreviousHomeNext

Pharmacy ServicesBehavioral HealthBenefits and EligibilityClaimsCoordination of BenefitsCustomer ServiceDME, Medical Suppliesand P & OHealth & WellnessLaboratory ServicesMusculolskeletal ServicesPharmacy ServicesPT, OT and STProvider Enrollment andChange RequestsProvider InquiryProvider OutreachQuality / Population HealthTravel ServicesUtilization Managementbcbsm.com ereferrals.bcbsm.comWith this information you can: Access information on theformulary, including thequality interchange program,formulary alternatives,quantity limits, genericsubstitution and drugcoverage Get help with pharmacyclaims processing issues Inquire about and requestprior authorization, benefitexception or urgent review ofpharmacy servicestheir member ID card.Mail-order optionsPharmacy Help DeskFor most medications For new prescriptions, callExpress Scripts at1-888-Easy-RX1(1-888-327-9791) for a faxform. For refills, call Express Scriptscustomer service at1-800-229-0832.For drugs covered under themedical benefit, refer to BCN’sMedical Benefit Drugs - Pharmacypage at ereferrals.bcbsm.com.Mailing address -- BCN HMO(commercial)BCN Pharmacy Help DeskP.O. Box 321127-511FDetroit, MI 48232-1127This information applies to BCNHMO and BCN Advantagemembers. For Blue CrossComplete pharmacy information,refer to the Blue CrossComplete Provider Manual atMiBlueCrossComplete.com/providersNote: The telephone numbersshown on this page are forproviders only. Members shouldrefer to the Customer Servicecontact information on the back ofDecember 2017Business hours24 hours a day, 7 days a weekPrior authorization requestsTelephone: 1-800-437-3803Fax: For BCN HMO (commercial),including self-funded plans:1-877-442-3778 For BCN Advantage:1-800-459-8027Mailing address -- BCN AdvantageBCN Advantage Pharmacy HelpDeskMail Code 1610P.O. Box 32877Detroit, MI 48232-1127For specialty medicationsWalgreens Specialty Pharmacy, LLCTelephone: 1-866-515-1355Fax: 1-866-515-1356Other informationClaims processing questions:Express Scripts Pharmacy ServicesHelp DeskTelephone: 1-800-922-1557Benefit / eligibility questionsrelated to pharmacy services:See the Provider Inquiry page.WebVisit bcbsm.com/providers QuickLinks Pharmacy Services.PreviousHomeNext

Physical, Occupational and Speech Therapy ServicesBehavioral HealthBenefits and EligibilityClaimsCoordination of BenefitsCustomer ServiceDME, Medical Suppliesand P & OHealth & WellnessLaboratory ServicesMusculolskeletal ServicesPharmacy ServicesPT, OT and STProvider Enrollment andChange RequestsProvider InquiryProvider OutreachQuality / Population HealthBCN contracts with eviCorehealthcare to manageauthorizations for membersreceiving physical, occupationaland speech therapy services inoffice and outpatient settings,including outpatient hospitalsettings.eviCore also manages physicalmedicine services delivered toBCN HMO members only: By chiropractors By athletic trainers, for datesof service on or after Jan. 1,2021Note: This informationapplies to both BCN HMOand BCN Advantage membersunless otherwise noted.For Blue Cross Completeinformation, refer to the BlueCross Complete Provider Manualat MiBlueCrossComplete.com/providersProcesseviCore healthcareSubmit prior authorizationrequests for both initial and followup treatment visits to eviCorehealthcare using one of themethods described in the Outpatientrehabilitation services frequentlyasked questions document.Prior Authorization Call CenterTelephone: 1-855-774-1317Monday – Friday (except holidays)8 a.m. to 7 p.m.Note: Initial evaluations do notrequire authorization.Other resourcesClick the links below to accessadditional information: BCN’s Outpatient PT, OT, STpage at ereferrals.bcbsm.com Utilization Management chapterof the BCN Provider Manual.Look in the section titled”Managing PT, OT and ST /Managing physical medicineservices.”CriteriaTo see the criteria eviCore usesto make determinations onauthorization requests:1. Open eviCore’ s ClinicalGuidelines webpage.2. Click Musculoskeletal: Therapies.3. Enter “Blue Care Network” as thehealth plan.4. Click the search icon.5. Click to open the desired criteriaset.WebVisit: evicore.com eviCore’s Blue Care Networkresources page atwww.evicore.comTravel ServicesUtilization Managementbcbsm.com ereferrals.bcbsm.comOctober 2020PreviousHomeNext

Provider Enrollment and Change RequestsBehavioral HealthBenefits and EligibilityClaimsCoordination of BenefitsCustomer ServiceDME, Medical Suppliesand P & OHealth & WellnessLaboratory ServicesMusculolskeletal ServicesPharmacy ServicesPT, OT and STThe process and formsused in enrolling andupdating information varywith the type of practitioner/ provider and the specificBlue Cross and BCNnetwork affiliation.For all providersAll the necessaryinformation is available atbcbsm.com/providers Quick Links Enrollment,Changes and Access Enrollment and Changes.Mailing addressBlue Cross Blue Shield of MichiganProvider Enrollment and DataManagementMail Code C301600 East LafayetteDetroit, MI 48226To enroll with or updateinformation for BlueCross Complete, 800-822-2761Fax1-866-900-0250Provider Enrollment andChange RequestsProvider InquiryProvider OutreachQuality / Population HealthTravel ServicesUtilization Managementbcbsm.com ereferrals.bcbsm.comApril 2021PreviousHomeNext

Provider Inquiry (non-behavioral health)Behavioral HealthBenefits and EligibilityClaimsCoordination of BenefitsCustomer ServiceDME, Medical Suppliesand P & OHealth & WellnessLaboratory ServicesMusculolskeletal ServicesPharmacy ServicesPT, OT and STProvider Enrollment andChange RequestsProvider InquiryProvider OutreachQuality / Population HealthTravel ServicesUtilization Managementbcbsm.com ereferrals.bcbsm.comContact Provider Inquiry to get helpwith general questions such as: Claim inquiries Member benefits information Primary care physicianassignmentsBCN HMO and BCNAdvantage ProviderInquiryMailing addressBlue Care NetworkGeneral CorrespondenceP.O. Box 68827Grand Rapids, MI 49516-8827WebVisit bcbsm.com/providers Contact us (at the top). Clickthe desired link under either the“Hospitals and facilities” or the“Physicians and professionals”heading.Provider Inquiry phone and fax numbers – all productsFor.During business hours.After businesshours.Member withPhone: 1-888-265-4703BCN coverageFax: 1-844-318-5145who is a BlueCross employeeCalls are answered onlyduring ombudsmanbusiness hours(Monday through Friday— except holidays —8:30 a.m. to 5 p.m.).Member withBCN HMO orBCN Advantagecoverage who isnot a Blue CrossemployeeThe automatedresponse system isavailable 24 hoursa day, seven days aweek.Call the appropriate Provider Inquirynumber: Facilities in Michigan:1-800-249-5103 Professional providers inMichigan: 1-800-344-8525 Hearing / vision providers:1-800-482-4047Provider Inquiry fax numbers: BCN HMO: 248-799-6969 BCN Advantage: 1-866-364-0080However, providerscan be connectedwith a Provider Inquiryrepresentative onlyduring business hours(Monday through Friday— except holidays —from 8 a.m. to 5 p.m.).Note: For provider inquiry information related to behavioral health services,refer to the Behavioral Health page in this guide.Blue Cross CompleteProvider InquiryFor information on BlueCross Complete, visitMiBlueCrossComplete.com/providersApril 2018PreviousHomeNext

Provider OutreachBehavioral HealthBenefits and EligibilityClaimsCoordination of BenefitsCustomer ServiceDME, Medical Suppliesand P & OHealth & WellnessLaboratory ServicesMusculolskeletal ServicesPharmacy ServicesPT, OT and STProvider Enrollment andChange RequestsProvider InquiryProvider OutreachQuality / Population HealthTravel ServicesUtilization Managementbcbsm.com ereferrals.bcbsm.comContact Provider Outreach to gethelp with: Contractual issues Recurring problems orunresolved issues Education and training onBCN policies, procedures andprograms Discussion of primary groupadministration Changes in primary carephysician acceptance codes Requests for coverage /on-call providersVisit bcbsm.com/providers ContactUs (at the top). Click the desiredlink under either the “Hospitals andfacilities” or the “Physicians andprofessionals” heading.East / Mid / SoutheastEast and Mid Michigan — LansingMail Code L09C232 S. Capitol Ave.Lansing, MI 48933Southeast — SouthfieldMail Code C30220500 Civic Center Dr.Southfield MI 48076West / Upper peninsulaWest Michigan — Grand RapidsMail Code G20686 Monroe Center NWGrand Rapids, MI 49503West Michigan — Traverse CityMail Code B210202 E. State St., Suite 200Traverse City, MI 48694Upper peninsulaTelephone: 1-866-497-7647Fax: 906-228-6588Mail Code B108415 McClellan Ave.Marquette, MI 49855-5506For primary care physicians in amedical care group, look on the listof physician organization consultantsto find your consultant.For other practitioners, reviewthe regional map for professionalproviders or the regional map forfacilities. Click your region on themap to see a list of professional orfacility consultants.March 2021PreviousHomeNext

Quality and Population HealthBehavioral HealthBenefits and EligibilityClaimsCoordination of BenefitsCustomer ServiceDME, Medical Suppliesand P & OHealth & WellnessLaboratory ServicesMusculolskeletal ServicesPharmacy ServicesPT, OT and STThe BCN Quality and Population Healthdepartment oversees activities relatedto: Quality of care / service concerns Clinical practice and preventivecare guidelines Coordination of accreditation andregulatory standards HEDIS * measures and initiatives Physician / provider medical recordreviews Facility reviews Physician office education Quality outcome measures Health promotion / education(including worksite wellnessprograms, community health fairs) Risk 8-455-2808Business hoursMonday – Friday, 8 a.m. to 4:30 p.m.Mailing address for quality management issuesBlue Care NetworkQuality ManagementMail Code C330P.O. Box 5043Southfield, MI 48076-5043Provider Enrollment andChange RequestsProvider InquiryProvider OutreachQuality / Population HealthTravel ServicesUtilization Management*HEDIS is a registered trademark of the NationalCommittee for Quality Assurance.bcbsm.com ereferrals.bcbsm.comApril 2018PreviousHomeNext

Travel ServicesBehavioral HealthBenefits and EligibilityClaimsCoordination of BenefitsUse the contact information onthis page to: Check eligibility Obtain benefit information Submit claimsCustomer ServiceDME, Medical Suppliesand P & OHealth & WellnessBCN members can use thenationwide network of Blue planproviders for health care needswhile traveling outside of Michigan.Out‑of‑state Blue Cross BlueShield members can have urgentand follow-up care services whiletraveling within Michigan.BCN and out‑of‑state Blue CrossBlue Shield HMO members canarrange treatment with a traditionalprovider who participates with BlueCross Blue Shield plans.Laboratory ServicesMusculolskeletal ServicesPharmacy ServicesMailing address – professionalclaimsBlue Cross Blue Shield of MichiganClaimsP.O. Box 312500Detroit, MI 48231-2500Mailing address – facility claimsBlue Cross Blue Shield of MichiganClaimsP.O. Box 310166Detroit, MI 48231-0166Business hours7 days a week, 24 hours a dayPT, OT and STProvider Enrollment andChange RequestsTelephone To check membership andeligibility, call1-800-676-BLUE (2583).Provide the operator with thethree‑character prefix on theID card. To find a provider, call1-800-810-BLUE (2583) or goto bcbs.com and click on theFind a Doctor link.Provider InquiryProvider OutreachQuality / Population HealthTravel ServicesUtilization Managementbcbsm.com ereferrals.bcbsm.comTravel services for BCNmembersMay 2022PreviousHomeNext

Utilization ManagementBehavioral HealthBenefits and EligibilityClaimsCoordination of BenefitsCustomer ServiceDME, Medical Suppliesand P & OHealth & WellnessLaboratory ServicesMusculolskeletal ServicesPharmacy ServicesPT, OT and STProvider Enrollment andChange RequestsProvider InquiryProvider OutreachQuality / Population HealthTravel ServicesUtilization ManagementBCN Utilization Management manages the following: Acute IP admissions / concurrent reviews Home health care services for BCN commercialmembers, for providers not contracted with BCN.Note: CareCentrix manages home health careauthorizations for BCN Advantage members. Home TPN and enteral feedings Post-acute care for BCN commercial membersNote: naviHealth manages post-acute careauthorizations for BCN Advantage members. Referral management Review of potential quality variances and seriousadverse events Transplant evaluations Social work services Review of provider appealsNote: All requests must include clinical information.For after-hours utilization management assistance, call1-800-851-3904 to: Determine alternatives to inpatient admissions Arrange for DME and for emergen

the address shown on this page Submit hard-copy facility claims on UB-04 forms to the address shown on this page. To inquire about a claim, do one of the following: Check claims status through the computer-based web-DENIS system. Call the appropriate Provider Inquiry telephone number. Send written inquiries about