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
Commercial Blue Cross Blue Shield of Michigan and Blue Care Network
- 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. - Preferred Drug List
To find out what drugs are the most safe and least expensive, read our preferred drug lists for Blue Cross Blue Shield of Michigan members.
Medicare Part D– Blue Care Network Advantage and Medicare Plus Blue PPO
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.
BCN Advantage HMO-POS formulary
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.