Refer lab, DME services within BCBSM networks (BlueCard)

Blue Cross and Blue Shield Association has clarified the rules pertaining to which Blue plan independent clinical laboratories and durable medical equipment suppliers must submit claims. Labs must now submit claims to the Blue plan in whose service area the lab was drawn. Previously, lab providers often billed the Blue plan where they were physically located and, if those providers were participating with that Blue plan, the claims were processed as participating or in-network through our BlueCardÆ program. Because of the BCBSA billing clarification, however, under the criteria described above, non-Michigan lab providers must now bill BCBSM instead of the Blue plan where they’re located. BCBSM doesn’t currently have participating agreements with most providers located outside of Michigan, so practitioners shouldn’t refer lab outside Michigan unless they’ve first verified with BCBSM that the provider participates in the member’s applicable BCBSM network. Otherwise, members will likely be subject to additional out-of-network cost-sharing. They may also be subject to balance billing by the out-of-state lab providers that aren’t participating or in-network with BCBSM.