Changes coming as Blue Cross Blue Shield of Michigan transitions to nonprofit mutual

As we told you about earlier this year, Gov. Rick Snyder signed Public Acts 4 and 5, the acts that enable BCBSM to begin its transition to become a nonprofit mutual insurer. During this process, we promised our health care providers that we would keep them informed of progress and any changes that could occur as a result of the transition.

Progress to date

• The transition is ongoing throughout 2013, and BCBSM will complete the transition by Jan. 1, 2014.
• The process of creating a new company and governance is being led by BCBSM’s board of directors.
• Internal teams are reviewing the Michigan Insurance Code, which will regulate us moving forward (like all other insurers in Michigan).
• Operational and business changes to operate as a nonprofit mutual company are under way and minimal.

What isn’t changing

• Our current health care coverage for your Blue Cross patients and our ongoing partnerships with physicians and hospitals to improve the quality of care
• Our core values as a nonprofit with a deep commitment to Michigan and our customers
• Our contributions to building a healthier future for Michigan

What will be different

• Provider class plans and their annual reporting will no longer be required.
  • BCBSM will continue to contract, set fees and policies, and regularly review performance based on provider groupings and types.
  • This is similar to the provider classes established through the Public Act 350.
• Some of our contracts include language regarding provider appeals under PA 350, and this will change.
• The appeals process

A closer look at the appeals process

• Under the Michigan Insurance Code, the Department of Insurance and Financial Services will no longer review provider appeals for audit and post-service claim determinations.
• In order to be compliant with the insurance code, the BCBSM appeals process no longer includes DIFS.
• The proposed process replaces DIFS or binding arbitration with an external peer review by an independent review organization for non-policy (medical or clinical) issues.
• The results of the external peer review will be binding on both parties.
• All providers will continue to have access to their current internal appeal process.

These changes will continue to be communicated in The Record and on web-DENIS, but they must be reviewed and approved through our board of directors. As a result, we will publish an official notification of changes in the October issue of The Record.

If you have any questions, please contact your provider consultant.