Plan Documents and Forms
Enrollment and changes
- Join Our Network
Find out how to join our network and gain valuable provider resources.
Non-contracted providers
- Waiver of Liability
Learn how to appeal a Medicare payment denial.
Chart requests
- Medical Record Retrieval and Review
Learn about the medical record retrieval and review process. Ciox Health is our vendor for medical chart retrieval requests for commercial and Medicare Advantage members.
Pharmacy services
Blue Cross Blue Shield of Michigan:
- Clinical Drug List
The clinical drug list is updated twice a year and provides a list of drugs covered by our plans. - Custom Drug List
The custom drug list is a prescription resource for members with three-tier or closed drug list plans. - Custom Select Drug List
The custom select drug list is for members with individual or small group health plans that meet the requirements of the Affordable Care Act. - Medicare Plus Blue PPO and Prescription Blue PDP Formularies
Find out what prescription drugs are covered under Medicare Plus Blue PPO and Prescription Blue PDP.
Blue Care Network:
- Custom Drug List
Take a look at our custom drug list, also called a formulary, to find out what prescription medications are covered. - Custom Select Drug List
The custom select drug list is for members with individual or small group health plans that meet the requirements of the Affordable Care Act. - Prior Authorization and Step Therapy Guidelines
Learn how the Prior Authorization and Step-Therapy Guidelines can help reduce costs while maintaining quality pharmaceutical care.
Medicare Part D
Pharmacy Provider Information
Get important information about Medicare Part D.
Blue Cross Complete
- Blue Cross Complete (Medicaid)
Get important information about Blue Cross Complete.
Wellness plans
- Physician Verification Form
Use this form to request a medical waiver or update us on the progress of patients enrolled in a wellness plan.
Supply forms
- Supply Forms
Learn how to order general administrative materials if you're a Blue Care Network, Blue Cross Blue Shield of Michigan, dental, or vision and hearing provider.
Referrals
- Referrals
Get access to out of network referral forms and learn how to submit referrals electronically.