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May 2018
Here are more details about changes to our professional provider consultant model
In the March Record, we told you we’d give you more details about upcoming changes to the Blue Cross Blue Shield of Michigan and Blue Care Network professional provider consultant servicing model in future issues. Here’s an overview of what’s changing and how we believe these changes will benefit health care providers going forward.
What’s changing
- We’re encouraging professional providers to always use the standard methods of communicating with us when first contacting us for information or assistance. These are outlined in our resource guides for Blue Cross and BCN.
- We’re improving our processes to better answer your questions and direct you to helpful tips and online information when you contact us the first time.
- We’ll soon be assigning our professional consultants to serve specific Blue Cross Physician Group Incentive Program physician organizations, known as POs, and Blue Care Network medical care groups, or MCGs, to provide education and training on our policies and programs.
How this will help you
- By directing health care providers to standard sources of information, such as Provider Inquiry, we can better identify problems, prioritize efforts and fix problems affecting multiple providers versus addressing issues one practice at a time.
- By improving our processes, we expect you’ll see incremental improvements, resulting in higher levels of satisfaction over time.
- By partnering more closely with POs and MCGs, group administrators can help us focus our educational efforts where they’re needed most.
What you need to know
Here are some important points to keep in mind.
- Contact Provider Inquiry for all claims issues. All professional claims inquiries must be directed to Provider Inquiry (1-800-344-8525 for medical providers; 1-800-482-4047 for vision and hearing providers), even complex claims issues. If your issue isn’t satisfactorily resolved, ask the representative to escalate your inquiry to their leadership.
- Consider joining a physician organization or a medical care group if you’re not already part of one. With the evolution of value-based reimbursement programs, you’ll receive the support you need to transition to a population management-based health care delivery system. Take a look at the groups that are available and see which one is a good fit for your practice.
- Our hospital and facility consultants haven’t changed. Most provider consultant assignments for hospitals and facilities haven’t changed, and the assistance they provide remains the same. If you’re with a hospital or facility, here’s how you can check your assigned provider consultant:
- Go to bcbsm.com/providers.
- Click on Contact Us in the right-hand corner of the page.
- Under Hospitals and facilities, click on either Blue Cross Blue Shield of Michigan provider contacts or Blue Care Network provider contacts.
- Click on Provider consultants.
We value your input about these changes. If you have specific comments or suggestions, contact provideroutreach@bcbsm.com.
We know it will take some time to transition to this new service model and perfect it, and ask for your patience over the next few months as we implement these changes.
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