Enrollment for BCBSM’s new freestanding radiology center provider type begins on Oct. 1

In the August Record, we explained that Blue Cross Blue Shield of Michigan is establishing a Traditional freestanding radiology center provider type. Establishing an FRC provider type allows us to uniquely recognize and reimburse freestanding providers of diagnostic imaging services. Members will have access to the new provider type, beginning Jan. 1, 2015.

Provider enrollment materials will be available on bcbsm.com on Sept. 17, 2014. Eligible FRCs, including those owned by hospitals, may enroll in the BCBSM Traditional FRC network, starting Oct. 1, 2014.

All participating FRCs will be considered in-network for PPO members, and out-of-network sanctions will be waived.

Creation of the FRC provider type within The Traditional network means that:

• BCBSM will designate FRCs as a unique provider type.
• BCBSM will formally contract with FRCs that are eligible to enroll, including those owned by hospitals, for the Traditional program.
• Participating FRCs will be included in provider directories at bcbsm.com and on the Blue Cross and Blue Shield Association^® website.
• BCBSM will list FRC cost information, by procedure, for each of the FRCs in the provider directories.
• FRCs will be reimbursed for all diagnostic imaging services that are covered benefits.
• Participating FRCs will be reimbursed using the BCBSM professional fee schedule. FRCs will not be eligible for the BCBSM Physician Group Incentive Program’s radiologist fee uplifts at this time.

Diagnostic imaging services performed in FRCs will be subject to the current Radiology Management program preauthorization and privileging requirements. (Please note that the Federal Employee Program^® is not subject to the Radiology Management preauthorization process.)

Qualified applicants that are currently enrolled as physician group practices will be asked to terminate their current provider identification number and enroll under a new one. The existing National Provider Identifier will be mapped to the new FRC record.

To apply, log in to the provider portal on bcbsm.com and follow these steps:

• Click on Enrollment and Changes.
• Click on Physicians and Professionals.
• Click on Enroll a new provider.
• Click on Freestanding Radiology Center in the provider type section.

Once you have received your FRC provider PIN, the provider PIN and NPI must be registered with our Electronic Data Interchange department for electronic claims submission. For questions about electronic claim submission or registering your NPI, visit bcbsm.com or call the EDI Help Desk at 1-800-542-0945.

As part of the enrollment process, BCBSM will be using AIM Specialty Health’s OptiNet assessment tool to collect information on our contracted providers’ imaging equipment and staffing credentials. OptiNet is an online tool that enables reporting of accurate and current information about the capabilities of participating imaging facilities and providers. BCBSM will publish more information about the OptiNet tool, provider registration and how to submit information in October.

For more details about the FRC provider type, please review the August Record article or contact your BCBSM provider consultant.