OSP News

Blue Cross Complete Claims Submission and Processing Guidance for Referring Providers

Posted: 10/08/2021

Effective immediately, claims for referring physicians must be submitted with a valid provider type and unique NPI. The referring provider must be an M.D., D.O., physician assistant, nurse practitioner or certified nurse-midwife. The rendering and referring provider cannot have the same NPI. If any of these data elements are missing or invalid, the claim will be denied.

For more details on claims submission and processing, see Section 13 of the Blue Cross Complete Provider Manual at mibluecrosscomplete.com and Section 11 – Billing Requirements in the Michigan Medicaid Provider Manual.

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