Blue Cross Blue Shield of Michigan (BCBSM) is the largest insurance network in the state of Michigan, with over 33,000 doctors in network at the non-profit. As the non-profit payer continues to shift to value based care - and as CEO bonuses at BCBSM continue to exceed 10 million dollars per year - more and more addiction treatment providers in Michigan are wondering if it is worth it to get credentialed and go through the enrollment process to become an “in network” provider with BCBSM.
Today, we’ll look at the pros and cons of credentialing and/or enrolling with BCBSM as an addiction treatment center or individual provider. We’ll also look at what the process entails.
What is the Difference Between Credentialing, Enrolling and Being “In Network” with BCBSM?
A definition of terms is useful here.
Credentialing - This is simply a process where BCBSM verifies you or your organization’s medical credentials. Completeing credentialing is the first step towards enrollment with BCBSM - or any other insurance company. Credentialing does not necessarily mean you are “in network” yet.
Enrollment - This is the process whereby addiction treatment providers become “in network” with BCBSM. When you are an enrolled provider, you have a group or individual contract with BCBSM.
In Network - This is another term for the state of being enrolled, as an individual provider or a group provider, with BCBSM.
What are the Pros of Credentialing or Enrolling with BCBSM?
There are many pros to enrolling with BCBSM.
For one, you’ll find that it is easier to attract patients when you are in network with BCBSM. This is huge because BCBSM is such a large payer in the area and commands such a large market share of patients.
Another consideration is the rate of reimbursement. While reimbursements for out-of-network or non-enrolled addiction treatment providers is typically lower than in network providers with any insurance company, you’ll find that this is especially the case with BCBSM.
In 2019, four addiction treatment centers in Michigan brought a lawsuit against BCBSM for failing to reimburse pre authorized out-of-network claims. The lawsuit also alleges that BCBSM intentionally makes it extraordinarily difficult to even file those claims in the first place by requiring all out of network providers to submit claims exclusively by traditional mail, which is unusual in the industry. While the lawsuit is still making it’s way through courts, a judge did deny a motion to dismiss the case, which bodes well for the behavioral health care entities eventually recovering their reimbursements from BCBSM. In any event, this lawsuit demonstrates that being out-of-network with BCBSM as an addiction treatment provider isn’t an ideal position to be in from a reimbursement point of view, at least until BCBSM revises - or is forced to revise - it’s addiction treatment reimbursement policies.
What Are the Cons of Enrolling With Blue Cross Blue Shield of Michigan?
The cons of enrolling with BCBSM are simply the time and effort it takes to complete the enrollment process. A typical enrollment process consumes about 10 hours of administrative work and BCBSM’s enrollment process should take about that long.
How Does Credentialing and Enrollment with BCBSM Work for Addiction Treatment Providers?
BCBSM Substance Abuse Facility General Information sheet is a valuable resource for understanding how addiction treatment reimbursement for credentialled and networked providers works at Blue Cross Blue Shield of Michigan. The document covers such topics as: mental health and substance abuse managed care, substance abuse facility reimbursement and approved services.
You’ll need to download, fill out, print and fax the 15-page New Facility Provider Enrollment Form. Make sure you fill it out electronically and then print it, as BCBSM states they will not accept handwritten forms.
Review the New Provider Checklist of Substance Abuse Facilities Before Credentialing and Enrolling with BCBSM
Before you begin the credentialing process, you’ll want to review the New Provider Checklist, which lists out all of the documents and pieces of information that you’ll need to complete the New Facility Provider Enrollment Form with BCBSM. You’ll find the specific list of needed items for Substance Abuse Facilities on page 7 of the 7-page document.
For Substance Abuse Facilities looking to get credentialed with Blue Cross Blue Shield of Michigan, the following requirements must be met:
Proof of Liability Insurance
Accreditation certificate from one of 6 accrediting bodies (ie. Joint Commission, CARF, etc)
Governance structure with named board members or member list
DEA license (for MAT services)
State of Michigan license for either residential, outpatient or MAT services
Proof of location in Michigan
NPI
Owner information
Tax TIN and payee name
Having Difficulty With BCBSM Addiction Treatment Reimbursements? We Can Help.
BehaveHealth’s Revenue Cycle Management (RCM) service includes soup-to-nuts, hyper-detailed, hands-on attention to every single component of your addiction treatment billing needs. We have strong working relationships with every major insurance company in the United States.
Even better, we’re not health care generalists. We only work for behavioral health providers like you.
Let our team of specialists handle it all:
Verification of Benefits
Utilization Review
Billing and Collections
Patient Responsibility
Denials and Appeals
Get your free trial started today and see why more addiction treatment centers prefer Behave Health.