WebContractor Attestation Form. Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. Contractor Attestation Form. Revision Date: March 2024 Page 1 of 1. HealthScreening Questionnaire. Webattestation must be up to date. If your CAQH application is not complete or if your attestation is expired after 14 calendar days, your request will be closed and you will need to reapply using the Mental Health Practitioner Change form. Section 1: Demographic Data *denotes a required field *First name Middle name *Last name

Provider Attestation Provider Attestation - BCBSKS

WebProvider Inquiry is for registered, nonregistered and out-of-state providers. Physicians and professionals: 1-800-344-8525. Hospitals or facilities: 1-800-249-5103. Vision and … Webfacility can submit the request to authorize an inpatient admissionon the third day. Note: This requires that the patient still receive treatment on day 3. Please attach relevant clinical documentation inclusive of day 1, 2 and 3 of the admission to … phil ivey vs borgata

Commercial PPO LTAC/SNF Enhancement Form - BCBSM

WebBlue Cross Blue Shield of Michigan has developed a Value-Based Reimbursement model to reward Primary Care Physicians and Specialists. This innovative approach to provider reimbursement, shifts from the traditional fee-for-service model to a value-based care model. Primary Care Physician Value-Based Reimbursement WebProfessional & Facility Supply Requisition Form. Fill this out to order general administrative materials you need when doing business with Blue Cross. PDF. This form is used with … Webrequirements, as outlined in this application. The facility must be ready for the on-site review at the time of submitting the application. If the facility is approved for program participation, the appropriate notification will be issued. If the facility is not approved, we will send notification in writing indicating the reason(s) for the denial. phil ivey vs andy beal