BCBSM Insurance Information Data Access

Click here for NCP’s “Table of Contents” machine-readable forms (MRF) link.

NOTE: file can be extremely large. Be sure your system can manage upwards of a terabyte of information.

• Group/TPA can click on the link to open the Table of Contents (TOC). In the TOC there will be links to each Payer Transparency file, maintained by BCBSM.
• The TOC’s MRF links will automatically update monthly

Details

Available Blue Cross data will be made accessible for retrieval through the link above. This addresses the responsibility for posting applicable data where the public can access.

Plans and issuers must make public all negotiated rates with in-network providers; allowed amounts and historical billed charges for out-of-network providers (for plan years beginning on or after January 1, 2022).

Out-of-Pocket Max Tool (PT): Requires plans and issuers to have a tool that displays personalized out-of-pocket expenses. The tool must include 500 shoppable services identified by the federal government by January 1, 2023, and include all other services by January 1, 2024.

For plan years beginning on or after January 1, 2022: Federal law prohibits surprise billing for all emergency services, some non-emergency services provided by a nonparticipating professional provider in a participating facility, and air ambulance; State law also prohibits surprise billing by Michigan nonparticipating professional providers in similar situations.

State of Michigan Resources

For Surprise Medical Billing Information for Providers, Carriers click here

For SURPRISE MEDICAL BILLING ARBITRATOR Application, Annual Attestation, and Change of Information Form, click here.