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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
Care Management
According to the Joint Commission, medication reconciliation is a formal process for creating the most complete and accurate list possible of a patient’s current medications and comparing the list to those in the patient record or medication orders.

Medication reconciliation is the process of comparing a patient’s medication orders to all of the medications that the patient has been taking. This reconciliation is done to avoid medication errors such as omissions, duplications, dosing errors, or drug interactions. It should be done at every transition of care in which new medications are ordered or existing orders are rewritten. Transitions in care include changes in setting, service, practitioner, or level of care. This process comprises five steps: (1) develop a list of current medications; (2) develop a list of medications to be prescribed; (3) compare the medications on the two lists; (4) make clinical decisions based on the comparison; and (5) communicate the new list to appropriate caregivers and to the patient.  (The Joint Commission. Medication reconciliation. sentinel event alert. 2006. http://www​.jointcommission​.org/SentinelEvents​/SentinelEventAlert/sea_35.htm.)
The following are frequently asked questions about billing CPT® Category II code 1111F, which is used for members enrolled in Medicare Plus BlueSM, BCN AdvantageSM, Blue Cross commercial, and most groups under Blue Care Network who received a medication reconciliation within 30 days of an inpatient discharge to home.

Click here for the Med Rec PDF form

Erica Ross, Clinical Services Manager
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 discuss the virtual site visit process.  
Each year, BCBSM randomly selects multiple practices units from each PO to participate in a site visit. The purpose of the site visit is to share best practices across the state, in an effort to decease overall healthcare costs while improving patient outcomes. For the 2022 calendar year, site visits will be held virtually, and a BCBSM field team member will review PCMH capabilities with your practice unit. We have reached out to all practice units who have been selected for a site visit for the 2022 calendar year. With any questions, please reach out to your practice coach.
Kathryn Correll-Rice, Manager of Quality Improvement Strategy
Corporate Affairs
With the ever growing need to reduce hospital admissions and re-admissions eClinical works (eCW) has developed a dashboard to help practices manage their patients through the transition of care process.   
The eClinicalWorks Transition Care Management module offers providers the tools and insight needed to provide the continuity and quality of care for patients moving between acute and ambulatory settings, while meeting regulatory and compliance requirements of the Centers for Medicare & Medicaid Services.
eCW’s module helps improve your practice’s efficiency and productivity. Manage patients, track appointments, reconcile medications, and better understand who is being hospitalized and why. The practice can email and text alerts and campaigns for better Patient Engagement.  Additionally, providers and staff can identify and close any remaining gaps in care, helping lead to higher quality medicine and better outcomes.
Key BenefitsDashboard for management of patients transitioning among care settingsAnalysis and tracking tools help ensure care is delivered on time to each patientImprove compliance and promote better health outcomes among your patientsEnhance patient engagement for better outreach to patients in need of services 
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 are 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; web-DENIS will be shutting down EOB 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; only 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
Human Resources
Top Five Strategies on How to Deal with Burnout

Burnout is a state where you are mentally, emotionally, and physically exhausted at the hands of stress within your work life. Burnout is the state that leaves a person completely drained of energy and demotivated to the extent that simple everyday tasks become impossible for them to do. As a result, a person suffering from burnout starts to fall behind in life quickly as they lose the ability and power to function correctly due to exhaustion and stress.  

Once you can identify that you are dealing with burnout, you can think of how you will pull yourself out of the given state.

Pay Attention to What is Stressing You Out 

The first step to dealing with the aftermath of burnout is not to let yourself be stressed by the same things that led you to this situation in the first place.  

To understand your burnout, you need to wake up and start to assess where you went wrong with stress in the first place. 
Think about what you do throughout your day and pick out the things that often cause you stress. It’s time to eliminate them from your daily life if you wish to free yourself of the feeling of getting lost within these certain aspects that hold you down.  

Think of What You Can Change for the Better 

Once you start to remove the things that stress you out, you may think that you are all set and ready to go. However, to honestly deal with the stage of emptiness you are left with after burnout, you need to start to better your life in all the ways you possibly can. 

Start to add more positive aspects to your life, even if they are as tiny as eating healthy and going to bed early. Then, when they come together, they will make a massive difference in your life. 

Get Yourself Back on Track by Prioritizing  

Prioritizing the neglect of your priorities got you into the state of burnout in the first place, you must make firm changes in your life regarding your priorities that help you from going back to square one.  

Add Structure to Your Life  

Creating structure means it’s time to pick up. After burnout, you may feel helpless, leaving you to keep in mind that it is never too late to pick up and start doing what is best for you. You can begin by adopting new hobbies, making new friends, and going home to see your family more often.  

Talk About it All. Consider Therapy  

After going through such a draining and helpless stage, you mustn’t hold everything you have witnessed inside you. Instead, at this point, you must share your feelings and start with the little things. Tell the people around you about your experience and what is inside your head.  

If you find it hard to open up to those close to you, you can always consider therapy, where you are given a safe space to let out everything you’re feeling without fear of any sort of judgment.

Robert Pejas, Director of Human Resources

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