DentaQuest

Jan 15, 2020

Notice for BCBSM Providers related to incorrect benefit info for members

IMPORTANT!   There are approximately 2,500 commercial groups that are currently reflecting incorrect benefits in Blue Cross Blue Shield of Michigan systems.   This impacts how covered benefits are appearing in the portal for your patients.  Below are some examples:  

• Member is showing covered under a Small Group Pediatric plan (which provides coverage only through age 19), when the member is covered under a Small Group plan (which provides benefits for all ages).
• Member on an Ortho plan is showing limited covered codes (typically ortho codes only).  Deductible, co-insurance and annual maximum accurately reflect covered categories such as preventive, diagnostic, restorative, etc. 

As we work to resolve this issue, it is important your patients continue to receive the valuable care that you provide.   

What you need to know:  

We are working as quickly as possible to fix this issue and expect to have it resolved by the end of January.     

To ensure that you receive the appropriate payment for services rendered, claims submitted:

• 1/16/2020 or later will be held for processing until the issue has been resolved.
• 1/15/2020 or earlier that have already been processed incorrectly, will be reprocessed in early February