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DME/P&O, medical suppliers and pharmacists
Blue Cross Blue Shield of Michigan contracts with DMEnsion Benefit Management to process and service claims for all codes with regional carrier jurisdiction and to provide a network for certain Medicare Plus Blue PFFSSM members.
See the Centers for Medicare & Medicaid Services' jurisdiction list* (PDF) of codes to determine where claims should be sent:
| CMS Jurisdiction | Send claims to… |
|---|---|
| All providers when treating Medicare Plus Blue members DME regional carrier jurisdiction |
DMEnsion Benefit Management |
| All providers Local carrier jurisdiction |
Your local Blue plan |
| Michigan providers when treating another Blue plan's Medicare Advantage member | BCBSM |
Pharmacists
Pharmacists who chose to become deemed providers may provide diabetic supplies, durable medical equipment, DME supply drugs or other Part B drugs (PDF) (immunosuppressive drugs, oral anti-cancer drugs, etc.).
See our frequently asked questions brochure (PDF) for more information.
Reimbursement
When treating members who use DMEnsion's network, network health care providers and non-network deemed providers are reimbursed according to the DMEnsion Benefit Management-contracted amount:
- Current DMEnsion Benefit Management reimbursement rate fee schedule (PDF)
- Fee schedule rates from Jan. 1, 2008 through Dec. 31, 2008(PDF)
- Fee schedule rates from Jan. 1, 2007 through June 30, 2007 (PDF)
- Fee schedule rates from July 1, 2007 through Dec. 31, 2007 (PDF)
For other Medicare Plus Blue PFFS group plans:
- Deemed providers are reimbursed at the applicable Medicare rates for regional carrier jurisdiction services.
- Local carrier jurisdiction services will be reimbursed at local carrier rates.
