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March 2013
Performance Recognition Program for Medicare Advantage PPO providers continues in 2013
BCBSM is continuing the Medicare Plus Blue PPOSM Performance Recognition Program for 2013. The program design remains unchanged from 2012.
The program recognizes your efforts to improve Medicare Advantage members’ health. Furthermore, it encourages your patients to take more active roles in their health and wellness. The Performance Recognition Program uses
the Health e-BlueSM online tool that gives you easy access to member data related to the program’s performance measures.
This tool allows viewing of the health registry, utilization of services and pharmacy information for our members. This enables you to remind and encourage your patients to obtain preventative services such as mammograms or eye exams.
The program has three main components:
Base PRP — The base PRP is a target based on certain preventive screenings and disease management measures. The measurement period runs January 2013 through December 2013. You receive the base PRP payment in July 2014.
Pay As You Go — This component focuses on Healthcare Effectiveness Data and Information Set measures. The measurement period is January 2013 through December 2013. You receive payments in October 2013 and June 2014 for services completed during 2013.
PRP Bonus — Bonuses are based on HEDIS measures within a specified measurement period. This bonus is paid once a year in June 2014.
Please visit the Health e-Blue home page (log in through Provider Secured Services) for all 2013 physician recognition information, including the specific metrics for each PRP component.
If you do not have access to Health e-Blue, contact your provider consultant who will facilitate immediate access. Please contact your provider consultant or Provider Relations manager below and they will assist in answering any questions you may have about the program.
Upper Peninsula Region
Michael Fedrizzi
Phone: 906-228-5457
Email: mfedrizzi@bcbsm.com |
