Medical Management
1.  Global and outpatient referrals go through Medical Network One’s POD’s system (  If you need assistance uploading a referral, send a fax to 248-475-5777 or a secure email to
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
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 we will discuss the upcoming 2022-2024 PCMH designation announcement.
Prior to September 1, 2022, BCBSM will release a list of practice units who received designation status for 2022-2024. If you practice unit does receive designation status you will maintain your VBR uplift from September 1, 2022- August 31, 2024. As a reminder, MNO nominates all practice units who qualify by having the minimum requirements in place. The requirements are as follows:At least 30 attributed BCBSM PPO patientsIncluding at least 2 metrics that can be calculated
Q/U score at or above the 20th percentile
Implement at least 50 PCMH capabilitiesIncluding 15 required capabilities
Your MNO practice coach will reach out to you once we are notified of new designation status. Please reach out to your practice coach with any questions.
Kathryn Correll-Rice, Manager of Quality Improvement Strategy

 Corporate Affairs

A recent poll of eClinicalWorks practices found that nearly one-third cited provider and staff buy-in as the biggest challenge to succeeding with Population Health and value-based care programs. That was followed closely by concern over tracking and managing all the data created by such programs.  For independent practice, Population Health solutions can pay for themselves if properly utilized.  Some of the tools that eClinicalWorks offers are:

HEDIS® Analytics has real-time filters that let practices quickly obtain the data they need without waiting for reports to be run. Using the compliant date filter, for example, practices can determine how many patients were brought into compliance with necessary exams and tests within a certain time — a great way to determine whether your workflows are working.

Pre-visit planning is easier because eClinicalWorks puts data from Population Health tools front and center within the Progress Note. Staff can simply open the Right Chart Panel to complete their pre-visit planning, close gaps in care, and prioritize diagnosis codes.

Monitoring practice performance is easier with the use of HEDIS Analytics and Hierarchical Condition Category (HCC) coding. Providers can see which noncompliant patients are lacking appointments and move proactively to schedule them. These tools help practices avoid having to play catch-up at the end of the year.

Practices can stratify performance by payer, provider, and patient so the practice knows where it must focus its resources and attention to have the greatest impact.

For more information on any of these products please reach out to Mark Lazar
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. This 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 ASAP; the last day to use web-DENIS has been extended and it already should be shut down. 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
Please see the attached care management billing reference document from Blue Cross Blue Shield.  The table included in pages 4-6 provides an excellent summary of Provider Delivered Care Management (PDCM) codes, including codes, descriptions, and documentation requirements.  Practice Transformation Institute (PTI) is now offering a concentrated training on care management billing and coding: Foundational Care Management Codes and Billing Opportunities.  To learn more, visit  Registration information for upcoming trainings is also included within this newsletter. 

Click here for the PDCM codes
Erica Ross, Clinical Services Manager

 Human Resources

How to Prove Your Investments in HR Technology Are Paying Off
Technology advances rapidly and, when it does, it’s tempting to invest in new—or replacement—technology. The next best thing is always on the horizon. But company budgets are tight, and leaders want to be certain they are making the right investments in new technology. How are HR professionals taking steps to prove that their investments in technology are paying off?  

The current climate has heightened the need for HR leaders to make strategic investments in their quest to attract and retain talent. Companies must have the ability to engage talent with speed and scale, otherwise they may miss out on top prospects and fail to retain high-value employees.

Technology can help. But HR leaders need to be able to build the business case for investments in technology, convincing senior leaders and others that these investments make sense and will pay off in measurable ways.

What Can Be Measured
There are a wide range of metrics that might be measured, alone or in combination, to support investments in HR technology.

HR tech investments help automate HR processes, improve communication and collaboration within organizations, and provide better data for informed decision-making.

Examples of what to look for:
-Increased productivity. One of the most obvious ways to tell that your HR technology is working is by looking at how productive your team has become. If tasks are being completed more quickly and with fewer errors, it is likely because of the new tools and systems you have in place.

-Improved employee engagement. If employees use the new system to access information and resources, it shows that they find it valuable and helpful. It’s also a sign that your HR technology is working well if you find that employees are collaborating more on projects.

-Increased employee retention. If you see a decrease in the turnover rate, it could be because your HR technology is making things easier for employees. Staff members who can easily access the information they need and feel that their voices are being heard are more likely to stick around.

-Greater efficiency in recruiting. For example, an applicant tracking system will allow you to fill open positions more quickly and with less effort. Additionally, you will be able to attract higher-quality candidates because of the increased visibility of your job postings.

-Reduced costs. If you’re spending less on paper and postage, it’s a good sign that your new system is working well,” he said. “Automating some of your HR processes also saves time, which can lead to reduced labor costs.

Robert Pejas, Director of Human Resources