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May 2015

Attention chiropractors: performance data and clinical resources available on provider support website

Since 2003, OptumHealth Care Solutions, Inc. and Blue Cross Blue Shield of Michigan have partnered to provide network chiropractors with access to evidence-based clinical resources with the goal of obtaining optimal outcomes for your patients. Keep in mind that you can use your provider ID and password to gain access to the Optum™ provider support website at myoptumhealthphysicalhealth.com — a site that provides access to your clinical profile and clinical resources.

Chiropractors were given a password and ID when they received their initial welcome letters. They can also get their password and ID by going on the website or by calling 1-800-873-4575, ext. 53121.

Because all health care providers in our TRUST PPO network contractually agree to provide members with efficient, cost-effective care, we monitor provider utilization performance. This is done with the understanding that unique aspects of your individual practice may affect your ability to perform within the averages established by your professional peers.

Unexplained high use and cost of care will result in your tier category being changed from “meets criteria” to “does not meet criteria.” Continued unexplained high variance from your peers may affect your continued participation in our PPO programs, and you may be contacted with concerns about your profile.

If you haven’t already done so, log on to the Optum website and familiarize yourself with some of the functions and clinical information presented. Key features include:

  • Convenient access to the Optum website at any time
  • Clinical resources available on the website include:
    • Your individual clinical profile where your performance is compared to the averages established by your chiropractic peers in our TRUST PPO program for the timeframe indicated.
    • How to read your clinical profile
    • Tiering criteria. Performance of each chiropractor will be compared to the averages established by your chiropractic peers in the TRUST PPO program for the same 12-month timeframe.
    • Education tutorials
    • Other useful links to evidence-based references

If you have any questions about the information in this article or want to discuss a Blue Cross clinical case, contact an Optum support clinician at 1-800-873-4575, ext. 53121. If you have any other questions, call our profile analyst at 313-448-7371.

We look forward to your success as a Blue Cross Blue Shield of Michigan network provider.

No portion of this publication may be copied without the express written permission of Blue Cross Blue Shield of Michigan, except that BCBSM participating health care providers may make copies for their personal use. In no event may any portion of this publication be copied or reprinted and used for commercial purposes by any party other than BCBSM.

*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2014 American Medical Association. All rights reserved.
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