TEL. | Medical Management |
| HELLO, JUST A REMINDER TO ALL THE PRACTICES – June 2022 1. Global and outpatient referrals go through Medical Network One’s POD’s system (www.mednetone.net). If you need assistance uploading a referral, send a fax to 248-475-5777 or a secure email to [email protected]. 2. Office managers can add new members to access PODS. Have the office manager log into the site and select “Request a New Account”. Our referral specialist checks the site daily and will set up new accounts as requested. 3. All MRI’s and CT Scans go through AIM now (1-800-728-8008). 4. All PT/OT/ST (physical/occupational/speech therapy) go through EVICORE (1-877-531-9139). Chiropractor referrals are only good until the end of the year. Initial referral is good for 30 visits and then unlimited after that. 5. Patients with BCN Advantage DO NOT need a global referral to see a specialist. They only need a referral for the procedure that they are having done (e.g. colonoscopy/EEG). 6. Diagnosis codes need to be specific. Please do not submit Z00.00 for any specialist. For example: Knee Pain Unspecified (need specific knee). – If we receive unspecified diagnoses, we will contact you for a different diagnosis. 7. Any practice that cannot get on to PODS and needs a referral completed can print this referral form, fill it out, and fax it to 248-475-5777. If you have any questions, please contact us, we are here for you. Stay Safe!!! Christina Pourcho, Referral Specialist Phone: 248-475-4759 Fax: 248-475-5777 Email [email protected] (SECURE EMAIL ONLY) Patient Centered Medical Home Welcome to the Blue Cross Blue Shield of Michigan Patient Centered Medical Home (BCBSM PCMH) monthly newsletter update! Each month we will bring together all relevant PCMH news and updates for our participating provider community. This month will serve as a reminder for the unconscious bias training requirement. PCPs who have not completed the PGIP unconscious bias education requirement will need to complete one hour of education to be eligible for VBR in future years. Providers may choose any option that aligns with the state’s newly finalized LARA requirements- a module name and attestation is longer required. Once a completion date for a PCP is reported to BCBSM, the requirement is met. Completion must be reported on or before July 1, 2022, to be eligible for VBR effective September 1, 2022. If you have yet to complete your unconscious bias education requirement, your practice coach will be reaching out to you to assist. Kathryn Correll-Rice, Manager of Quality Improvement Strategy Corporate Affairs eClinicalWorks is one of the few vendors that offers clients a choice of Revenue Cycle Management solutions – a self-service Practice Management model in which you handle your own billing, or an RCM Service model in which eClinicalWorks provides a complete end-to-end solution for your practice. Revenue Cycle Management Product: Simple, Easy and Efficient When you choose eClinicalWorks, you hold the tools for RCM success in your hands. You will be able to utilize their automated claim submission and automated ERA posting and patient statements. Alert Dashboards Manage and prioritize claims to avoid missing payer timely filing windows. Performance Evaluation Tools Monitor your financial health using eClinicalWorks’ RCM Dashboard and Provider Analytics as well as practice KPIs. If you have any further questions about this, please feel free to reach out to Mark Lazar [email protected] Mark Lazar, Director of Corporate Affairs |
| Quality Improvement |
| Welcome to the quality improvement portion of the newsletter. We will be going over important updates to quality measures and changes that may occur throughout the year. This month we will be touching on Blue Cross Blue Shield switching from web-DENIS over to a new service/tool. The company Availity provides a multi-payer portal, called Availity Essentials. In the coming month, Blue Cross Blue Shield will be transitioning from web-DENIS over to using Availity Essentials. Availity Essentials is also used by other payers in the state of Michigan, including Aetna, Humana, and Molina. So, if you already have an account and are setup on Availity with them, there is no new logins that need to be created. However, if you, or someone at your office, do not already have an Availity login, then it will be extremely important to get them created immediately; web-DENIS will be shutting down around June 21st. While the current web-DENIS system will no longer be available, all the functionality that was found in web-DENIS will be available through the Availity Essentials tool and should not look any different; just the new accounts will need to be created. There are a lot of great resources available that detail what needs to be done on the provider side. If you have not already seen some of these documents sent directly to you, please reach out. We are happy to forward along FAQs and other documents, while assisting you in this process. If you have any questions, do not hesitate to reach out! Andrew Kurecka, Director of Innovation and Research Improvement Care Management Care Management: Updates to PDCM Outcomes VBR Provider Delivered Care Management (PDCM) outcomes VBR PaMPM is turning back to percentage based PDCM outcomes VBR effective 5/1/22. This means practices will temporarily receive VBR as they previously did prior to the PaMPM change. BCBSM is working on a long-term solution and back payment to providers. Please see the collaborative site for more information or reach out to us directly. Erica Ross, Clinical Services Manager Human Resources Official unemployment is near a historic low while job openings have surged to record highs, yet a massive gap remains between the demand for talent and the supply of workers in the labor market. The slow recovery in workforce participation is one of the factors at play. Millions of people who had been working in March 2020 or who would normally be in the labor force absent the pandemic have not rejoined or started their careers in the working ranks. The U.S. is missing about 3.5 million workers due to the pandemic, according to Nicholas Bloom, a Stanford University economist who recently crunched the numbers. The Society for Human Resource Management (SHRM) released new survey data about how people are assessing whether to return to the workforce. The research found that 37 percent of sidelined U.S. workers reported feeling indifferent about returning, 27 percent said they had mixed feelings about returning to work, and 18 percent said nothing could compel them to return. About one-fifth (21 percent) of surveyed workers said they felt anxious about returning to the workforce, and 17 percent have concerns over recent workplace requirements around vaccine and mask mandates or the lack of those safety measures. Twenty percent of all respondents who are not working said the opportunity to work remotely would motivate them to return to the workforce. For others, flexibility is the key. Looking at those who have exited the labor force and are not retired: -23 percent said that available jobs are not in their field of work interest. -17 percent said they haven’t been able to find a job that pays enough. -9 percent said they have chosen to learn new work skills or want to pursue a different career path. -27 percent said that if their savings ran out or ran low, it would motivate them to return. Robert Pejas, Director of Human Resources |
