Introduction to Team-Based Care

  • December 7, 2022 8:00am-12:30pm AND
  • December 8, 2022 9:00am-11:30am
  • (Must attend both days to get credits)

Register here:

Click here to view the flyer.

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 248-475-5777.8.  As of April 1st Availity Essentials is now Blue Cross Blue Shield of Michigan and Blue Care Network’s provider portal.

8.  As of April 1st Availity Essentials is now Blue Cross Blue Shield of Michigan and Blue Care Network’s provider portal.

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 review the 2022 PCMH Nomination and

Designation cycle:

BCBSM’S PCMH designation program has transitioned to a two-year designation. The current PCMH cycle is from 9/1/2022-8/31/2024. Nomination for the current cycle took place in October 2021. Mid Review-Cycle nominations (discussed in last month’s newsletter) for practices who are new to MNO or did not receive PCMH designation 2022 were completed in October 2022.

PCMH Designation Criteria:

-Practice unit is eligible to receive a Q/U score
-Practice unit Q/U score is at or above the 20th percentile
-Practice unit has implemented at least 50 PCMH capabilities
-Practice unit has implemented all 15 core PCMH capabilities

Multiple MNO practice units received BCBSM PCMH Designation for the first time in 2022:

-Cass City Medical Practice
-Central City Integrated Health
-Hazel Park Primary Care
-Neighborhood Primary Care
-Osteopathic Health Care Associates
-Putman Family Medicine

Congratulations to all practices who received PCMH designation in 2022!
Additionally, PCMH packets have been sent or delivered to all PCMH practice units. The packets include PCMH certificate, PCMH window clings, Value Based Reimbursement uplift (VBR) information, and other documents. MNO practice coaches are scheduling and conducting regular PCMH meetings with all practices to review the materials. Please contact your practice coach if you did not receive PCMH materials or have not yet scheduled your PCMH meeting.

Samantha Karson, Population Coach
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 going over end of the year gap closure and what some of the key deadlines are. With December 31st, 2022 approaching, it is important to recognize those patients who still have gaps-in-care. There is still time, albeit not a lot, to get some patients in for annual well-visits, or opportunities for preventive care/treating chronic conditions. For gaps-in-care to be closed for the 2022 measurement year, the service must be completed prior to January 1st, 2023. On top of this, there are opportunities to enter supplemental data into payer portals, in order to ensure the highest quality scores possible. If you have specific questions about submitting supplemental data on top of entering data into payer portals, please reach out to Andrew, Kathryn, Samantha, or Katie.

Andrew Kurecka, Director of Innovation and Research Improvement
Care Management
As a reminder for PDCM practices working toward engagement and outcomes Value Based Reimbursement (VBR), dates of service must be completed by the end of the year to be considered for the 2022 calendar year.  To earn the engagement uplift, practices must engage at least 4% of their eligible PDCM population.  Engagement is defined as having billed two PDCM codes on two different dates of service.  The payment model for outcomes VBR has shifted to a PaPMPM model and includes the following measures: A1C, Blood Pressure, Inpatient, and ED utilization for adults.  Pediatric measures include the same utilization metrics, follow up after emergency department visit for mental illness, and asthma medication ratio.  For the most current PDCM engagement reports, including claims data, please contact Erica Ross at
Erica Ross, Clinical Services Manager
Human Resources
CMS Issues Revised Staff Vaccination Guidance

On Oct. 26, the Centers for Medicare & Medicaid Services (CMS) issued revised guidance on COVID-19 vaccination requirements for staff working for Medicare-certified and Medicaid-certified providers and suppliers. While the revised guidance was issued in separate provider-specific attachments, the guidance generally allows for more flexible staff vaccination requirements and enforcement due to relatively low COVID-19 hospitalizations and deaths nationwide.

For long-term care and skilled nursing facility staff, CMS loosened the language around the 100 percent staff vaccination requirement, and CMS now defines noncompliance as staff vaccination rates under 100 percent of unexcepted staff, whereas the guidance previously did not distinguish unexcepted staff from the vaccination requirement.

The term “unexcepted staff” excludes those who have been granted exemptions from the COVID-19 vaccine or those for whom the COVID-19 vaccination must be temporarily delayed, as recommended by the CDC. This updated definition of noncompliance for long-term care and skilled nursing facilities now brings the staff vaccination requirements in line with those of other types of facilities, such as ambulatory surgery centers, hospitals, and hospice facilities.


In addition, the revised guidance provides for a more relaxed enforcement scheme with the scope and severity of citations now influenced by good-faith efforts made to correct noncompliance. The severity and scope levels range from Level 1, described as “no actual harm with potential for minimal harm,” to the most severe level, Level 4, described as “immediate jeopardy, noncompliance resulting in serious harm or death” or “noncompliance resulting in a likelihood for serious harm or death.”

The guidance allows for enforcement flexibility where there are good-faith efforts made to correct noncompliance, and it states that noncompliant facilities that have implemented a plan to achieve a 100 percent staff vaccination rate would not be subject to an enforcement action. On the other hand, the guidance states egregious noncompliance, described as more than 50 percent of staff being unvaccinated, should be cited at the harsher severity Level 2, which represents “no actual harm with potential for more than minimal harm that is not immediate jeopardy.”
Robert Pejas, Director of Human Resources