BCBSM to change professional provider fees July 1

BCBSM will change practitioner fees, effective with dates of service on or after July 1, 2014, for services provided to our Traditional, TRUST and Blue Preferred Plus^SM members, regardless of customer group.

BCBSM will use the 2014 Medicare resource-based relative value scale for all relative value unit-priced procedures for dates of service on and after July 1. Most fees are currently priced using the 2013 values.

Changes in resource-based relative values can impact fees. Procedure code maximum fees will increase or decrease based on the new relative value units and BCBSM’s conversion factors.

At the same time, the non-relative value unit-based anesthesia services will be increased by 1.5 percent in West Michigan and the rest of the state.

We conduct a comprehensive analysis of professional provider performance and current economic indicators annually to calculate practitioner fees, with consideration for corporate and customer cost concerns. BCBSM remains committed to reviewing professional provider performance to determine the need for increases or decreases in our maximum payments.

Fee schedules with the new fees that are effective July 1, 2014, will be available on web-DENIS April 1. Click on Entire Fee Schedules and Fee Changes on the web-DENIS BCBSM Provider Publications and Resources page to find fee information. Only claims submitted with dates of service on or after July 1 will be reimbursed at the new rates.

Please note that the Physician Group Incentive Program physician organization reward component of professional fees remains the same this year.

For more information, contact your BCBSM provider consultant.