CommercialAdministrativeHigh impact
Changes are coming to incident-to billing policy for Blue Cross, BCN commercial
BCBS Michigan·MI·Claims & Billing
Effective date
Sep 1, 2026
We identified it
Jun 16, 2026
Summary
Blue Cross Blue Shield of Michigan and Blue Care Network are phasing out incident-to billing for commercial members. Starting September 1, 2026, incident-to claims must use modifier SA and won't receive value-based reimbursement. By March 1, 2027, eligible providers must bill under their own NPI or receive only 80% reimbursement.
Action Required
By September 1, 2026: Billing team must add modifier SA to all incident-to claims for Blue Cross/BCN commercial members. Update billing system to flag these claims as ineligible for value-based reimbursement. By February 28, 2027: Eligible providers (physicians, nurse practitioners, physician assistants) must enroll with Blue Cross/BCN to obtain their own NPI for direct billing. By March 1, 2027: All eligible providers must bill under their own NPI - continued incident-to billing will result in 20% payment reduction and loss of value-based reimbursement eligibility.