Program Responsibilities of Physician Organizations

The PO will perform and bear the cost of the following:

  • Provide administrative and performance information requested by Blue Cross Blue Shield of Michigan so that Blue Cross Blue Shield of Michigan can fully coordinate, evaluate and conduct PGIP activities.
  • Work collaboratively with Blue Cross Blue Shield of Michigan and other POs to promote best practices, to equitably and appropriately resolve member and practice unit overlap issues and optimize the program's ability to meet its goals. (Note: Member is an individual physician practicing with the PO for any period of time during the term of this Agreement. Practice unit includes, but is not limited to, one or more members within a PGIP PO who share clinical responsibility for a group of patients and share common clinical processes of care, such as information systems, medical records and after-hours contact procedures. This definition may change from time to time as determined by PGIP policies and operating procedures.)
  • Provide Blue Cross Blue Shield of Michigan with a list of all physician member providers and practice units who are affiliated with the PO and collaboratively reconciling the list to ensure each member is represented in accordance with PGIP policies and operating procedures. For each member, identify Drug Enforcement Administration number, degree, primary practice address, specialty designation, practice unit, Blue Cross Blue Shield of Michigan PIN, National Provider Identifier, or other required identifier, and any other information that Blue Cross Blue Shield of Michigan may reasonably require to administer PGIP.
  • Collaborate with Blue Cross Blue Shield of Michigan to communicate with members regarding the implementation, administration and/or improvement of the PO's performance in the program. The form of this communication will be agreed upon by Blue Cross Blue Shield of Michigan and the designee.
  • Participate in meetings or conference calls with Blue Cross Blue Shield of Michigan to exchange information, discuss PO performance and develop methods for improving performance. POs will assign medical leadership to participate in these activities and take an active leadership role in administering the program within their PO to their members. POs should subscribe to the Blue Cross Blue Shield of Michigan Record and Value Partnerships Update to stay informed about all developments regarding the program.
  • Hold Blue Cross Blue Shield of Michigan and its customers harmless from any claims or losses arising out of any action with respect to calculation or distribution of any payments to members.
  • Permit Blue Cross Blue Shield of Michigan upon reasonable notice and during regular business hours to audit records related to the PO's performance in the Program, including records containing personally identifiable health information of Blue Cross and Blue Shield of Michigan enrollees, and Blue Cross and Blue Shield of Michigan Patient-Centered Medical Home designation.
  • Retain records relating to the PGIP Agreement and the PO's performance in the program for a period of six years following its termination in a form that readily permits review by Blue Cross and Blue Shield of Michigan.
  • Agree that all Incentive Payments made pursuant to the PGIP Agreement are made at Blue Cross and Blue Shield of Michigan's sole discretion in accordance with program guidelines. If a PO disagrees with a payment, it may submit a written request for reconsideration to Blue Cross and Blue Shield of Michigan. Blue Cross and Blue Shield of Michigan will review and respond to such request within one month. Blue Cross and Blue Shield of Michigan's decision will be final and binding.
  • Agree to comply with all program policies and procedures which are set forth in the PGIP program standards.

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