Care Management

Effective January 1, 2023, the Provider Delivered Care Management (PDCM) codes currently billable for care management services delivered to PPO members will now also be allowed for BCN and BCNA members.  The following claim codes are reimbursable for PCMH-designated providers (or mid-level providers billing under a PCMH designated provider):
 
HCPCS Codes: G9001, G9002, G9007, G9008, S0257.  
 
CPT Codes: 98961, 98962, 98966, 98967, 98968, 99487, 99489.
 
Some self-funded employer groups may elect not to participate.  Providers may check member coverage on Availity to determine if the member is eligible for PDCM.
 
Erica Ross, Clinical Services Manager
 
Medical Management

HELLO, JUST A REMINDER TO ALL THE PRACTICES – January 2023
 
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 cpourcho@mednetone.net.
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.

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  cpourcho@mednetone.net (SECURE EMAIL ONLY)

 
Human Resources

On January 1, 2023, Michigan’s minimum wage rate is increasing  from $9.87 to $10.10 per hour as set by Michigan’s Improved Workforce Opportunity Wage Act of 2018 establishing the annual schedule of increases.

On January 1, 2023:The minimum hourly wage will increase to $10.10 per hour.The 85% rate for minors aged 16 and 17 will increase to $8.59 per hour.The tipped employee rate of hourly pay increases to $3.84 per hour.The training wage of $4.25 per hour for newly hired employees ages 16 to 19 for their first 90 days of employment remains unchanged. 
Robert Pejas, Director of Human Resources
Provider Services

Welcome to the Provider Services portion of the newsletter. Meet the Provider Services team! Charlett Braxton is a Provider Liaison who wears many hats and has been with MNO for 26 years! The newest member of the team is Jennifer Charbonneau. She is a Credentialing Specialist with over 20 years of experience within the health care field and was also a Veterinary Technician for a few of those years.

Charlett and I are currently in the process of adding information into our new credentialing software program. This program will make the process of credentialing and recredentialing more effective and efficient. Unfortunately, we are noticing that there are discrepancies with demographics, contact information, or if a provider is no longer with a group, etc. It is imperative that we have the correct and most recent information, or the credentialing process cannot be done in a timely manner. The providers CAQH is an excellent place to keep the provider and the groups information up to date.

Back in December 2020, the No Surprises Act was signed into law to help patients avoid unexpected medical bills. Among other measures, the Act accelerates the average turnaround time in which commercial health plans must update their directory information and it’s required that they implement a process to remove clinicians and facilities from their directories when information cannot be verified.

The No Surprises Act has made re-attesting provider information with ALL payors every 90 days mandatory! By re-attesting, you are ensuring that the providers CAQH is up to date with any changes and/or additional information that has been added. Failure to meet this requirement means that you risk losing your payor contract (without warning).

Please reach out to Provider Services with updated demographic information and a contact person with their email and phone. This will make the credentialing process more effective and efficient. Send information or questions to Jennifer at jcharbonneau@mednetone.net and Charlett at cbraxton@mednetone.net
 

Introduction to Team-Based Care

About the Course:
The Introduction to Team-Based Care course helps the learner better understand how to work in a multidisciplinary care team and in collaboration with the patient. Open to all members of the practice to gain foundational knowledge in Team-Based Care. Introduction to Team-Based Care will include:
 Why, What, Who and How: Team-Based CareCare Management ProcessOutcomes and Triple AIMBilling Applications *This course is required for all care team members new to their role in order to bill PDCM codes.
 
Cost: Complimentary to MNO Practices
 
Successful Course Completion includes:Attendance at the entire course.  If attending live virtual, you must have audio and see the live slidesCompletion of the course post-test:  need to have a score of 80% or greaterCompletion of the course evaluation 
Please visit the MICMT website or www.transformcoach.org for additional information.
 
If you have any questions, contact Yang Yang at yyang@transformcoach.org
Course Date and Time: (Live Virtual)
March 1, 2023        8:00am – 4:00pm
(Must attend all day to receive credits)

May 24, 2023        8:00am – 12:30pm
May 25, 2023        9:00am – 11:30am
(Must attend both days to receive credits)

July 19, 2023        8:00am – 12:30pm
July 20, 2023        9:00am – 11:30am
(Must attend both days to receive credits)

OPPORTUNITY TO EARN CONTINUING EDUCATION CONTACT HOURS

Nursing:

  • Upon successful completion of the Introduction to Team Based Care Course, the participant will earn 5.5 Nursing CE contact hours
  • Michigan Institute for Care Management and Transformation is approved as a provider of nursing continuing professional development by the Wisconsin Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation.  WNA Activity# 2020-0000001417

Social Work:

  • Upon successful completion of the Introduction to Team Based Care course, the participant will earn 5.5 Social Work CE contact hours
  • Michigan Institute for Care Management and Transformation is an approved provider with the Michigan Social Work Continuing Education Collaborative.   Approved provider Number: MICEC 110216

Registered Dietitians