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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
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 codes to which value-based reimbursement applies for primary care physicians. 

For PCPs, VBR applies to the following evaluation and management codes: 

For PCPs, VBR also applies to the following vaccine administration codes: 
0021A-0022A (not yet covered)

Additionally, if a PCP participates in the Provider-Delivered Care Management program and is awarded PDCM-associated VBR, VBR also applies to the following codes: 

Should a PCP offer Telehealth coverage, VBR applies to the following codes: 

Kathryn Correll-Rice, Manager of Quality Improvement Strategy 
Corporate Affairs
Improving compliance requires more than identifying gaps in care. Practices need ways to act upon the comprehensive knowledge they have of their patients. eClinical Works Disease Explorer offers better visibility and sharper insight into patient populations by enabling practices to group patients into cohorts based on common needs.

With Disease Explorer, your practice can target high-risk patients, identify those patients who are waiting for test results, and prioritize patient care. Identify opportunities to close care gaps, dynamically investigate disease risk among your patient population, and achieve cohort-based population management.

Disease Explorer offers practices new perspectives and tools:
•    Organize patients by demographic data, medical condition, severity, or noncompliance with specific health measures or recommendations
•    Identify patients who need your attention soonest
•    Apply dynamic analysis to create actionable cohorts
•    Use social determinants and demographic factors to identity and analyze gaps in care
•    Target and hone your outreach and intervention efforts to get the right message to the right patients
•    Save staff time by leveraging integration with eClinicalMessenger®

If you have questions about Disease Explorer or other eCW functionalities please contact Mark Lazar at

Mark Lazar, Director of Corporate Affairs
Foundational Care Management Codes & Billing
September 15, 2022
Register Here:

Click here to view the flyer.
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
Update to Provider Delivered Care Management (PDCM) Outcomes Value Based Reimbursement (VBR) Payment Model (from BCBSM)

As previously communicated over the past few months, there were issues attributed to the PDCM outcomes PaMPM VBR payment, resulting in the project being paused. The PaMPM dollar VBR will relaunch with July 1, 2022, dates of service. A business decision has been made to allow the percentage VBR to continue until October 31, 2022, to make the practices whole for payments missed from January through April 30, 2022. Both the dollar and percentage VBR will run in parallel until October 31, 2022.

Erica Ross, Clinical Services Manager
Human Resources
Tight Labor Market Double-Edged Sword for Workers
It’s easy to assume that when workers are in high demand and short supply, as with the current labor market, it’s a great situation for employees. Indeed, in many ways, it is. Workers have much greater bargaining power in this market compared with, say, the situation in 2008. They can demand higher wages and have more opportunities to find better jobs with other employers.

So, what possible negatives could exist in this dream market for workers?

Employees Facing Increasing Demands
Well, the flip side is that it’s not just employers that suffer when they can’t find enough help. Employees working for short-staffed employers generally must handle more work, and that might mean working longer hours or juggling more tasks. For hourly workers, that might mean lucrative overtime, but for salaried employees, it’s just longer hours and more stress.

The impact on employees can have a downward spiral effect on employers, whose workers have become increasingly overworked, frustrated, and burned out and may leave to find better opportunities. This, of course, leaves employers even more short-staffed than they already were, putting even greater strains on the remaining staff.

Automation Leads to Efficiencies
A straightforward fix for this problem would be to simply hire more workers, but that is the whole problem—employers can’t find more workers! Instead, employers should consider ways to operate more efficiently with the workers they have.

This could mean greater automation, utilization of nonhuman resources like robotic process automation (RPA) and other tools, and increased training to help employees perform their tasks more efficiently. Some workers may have inherited tasks from departing colleagues and have little experience in performing them, so training can go a long way toward improving productivity and reducing stress.

A tight labor market is great for workers in terms of bargaining power and employment options, but these workers also must deal with many of the same stresses their employers struggle with when they are short-staffed. In the absence of available labor, employers and employees would therefore both benefit from increased efficiencies.

Robert Pejas, Director of Human Resources

Introduction to Team-Based Care

  • September 28-29, 2022
  • December 7-8, 2022

Register here:

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Introduction to Palliative Care
September 21, 2022
December 8, 2022
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Unconscious Bias in Healthcare
September 14, 2022
October 12, 2022
November 16, 2022
Register Here:

Click here to view the flyer.