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Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association.

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Presentation on theme: "Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association."— Presentation transcript:

1 Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association. BCBSM MiPCT Member Lists: Webinar 7/24/12 and 7/26/12

2 What is the member list? Sent monthly to POs –POs will receive each month once list is available in their EDDI folders –POs are responsible for distributing to all care managers working in participating practices as soon as possible Patients on list are eligible for care management and are attributed to a MiPCT Physician based on BCBSM data. –List is source of truth. If a patient is included on the monthly list, practice unit staff can assume the patient has BlueHealthConnection, is part of a participating employer group, and is eligible to receive care management services. –If patient is not on list, cannot assume they will be eligible for care management services in the future –List is relatively stable and should not change that much from month-to-month. May see more movement in the 1 st quarter of every year due to the renewal process 2

3 Member List, contd. Note: Practice encouraged to use Web-DENIS or CAREN to check patient has active BCBSM coverage before delivering care. Once POs have distributed the list of eligible patients to participating practices, the practices will review the list. –BCBSM is exploring ways to sort list prior to sending to POs. For more info on this or to provide feedback, please see the 7/23/12 edition of MiPCT Flash List includes information about patients health status and recent health care use, such as emergency department visits –These data flags are used to indicate pertinent patient data –Flags of interest may include high_deduct_plan and pharm_specialty, e.g. –For more info, refer to data dictionary 3

4 Member List, contd. List should be used in conjunction with the providers clinical information and knowledge of the patient to decide who should be offered care management. –Patients will be contacted by the practice to initiate care management process once they are determined to be eligible and a suitable candidate for outreach Currently exploring possibility of Michigan Data Collaborative distributing all member lists for MiPCT by end of 2012; more info coming soon! 4

5 Where does member list data come from? The information in the list is based on BCBSMs Care Relationship algorithm. –Based upon a review of claims for eligible Blue Cross Blue Shield of Michigan members (rendering provider field is used) –Claims taken from an outpatient hospital or office setting with dates of service within the past 2 years (using a 2 month run out). –Filtered by specific procedure codes: Base evaluation and management services, or New procedure codes for preventive counseling, immunizations or consultations. 5

6 Resources The following documents are available on the MiPCT web site: –Data dictionaries for both Commercial and MA populations –A Frequently Asked Questions document –Instructions for importing the patient lists 6

7 Member List Demo Now we will go step-by-step through opening and using the patient lists … 7

8 Questions?? 8


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