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August 2016

Here’s what you need to know about Blue Cross® Personal Choice PPO

As you read in the April Record, we’re launching an innovative product called Blue Cross Personal Choice PPO.

The product gives members high-quality care and an opportunity for lower out-of-pocket costs when they work through our Organized Systems of Care program. It also offers access to the broader PPO network.

Members began enrolling June 1, with coverage beginning Oct. 1, 2016.

Training opportunities
To make sure you know all you need to know about this new plan, we’re offering a wide range of training opportunities. They include the following initiatives:

  • Provider consultants will visit individual practices throughout August and September.
  • You can participate in a Personal Choice PPO webinar (details below).
  • If you can’t make one of the webinars, you can watch an e-learning video at a time that is convenient for you. Starting in mid-August, you'll be able to access it at brainshark.com/bcbsm/personal-choice-ppo or by going to ereferrals.bcbsm.com, clicking on Blue Cross and then on Blue Cross Personal Choice PPO.

Webinars
Webinars will be held at 10 a.m. or 1 p.m. on Sept. 20, Sept. 28 and Oct. 6. The webinar registration form has been posted on web-DENIS on the Provider Training page and on the e-referral website. You can get more information about the webinars and access the webinar invitation by clicking here or by following these steps:

 e-referral process
As part of the plan, members who select a primary care doctor who affiliates with a Level 1 OSC and who use other health care providers associated with that OSC receive high-quality, coordinated care at the lowest out-of-pocket cost. Members who have selected a primary care doctor in a Level 1 OSC but who seek services from other doctors and hospitals outside of that OSC will need to seek a referral from their primary care doctor in order to stay at the Level 1 cost share.

An e-referral process has been developed to help manage your referrals electronically. If you already use the e-referral system for your Blue Care Network patients, you already have access to the new Blue Cross Blue Shield of Michigan e-referral system. If e-referral is new to you, here’s how it works:

Requesting access to e-referral

Submitting referrals

  • Go to ereferrals.bcbsm.com and click on Login.
  • Click on BCBSM e-referral.
  • Choose Submit Referral from the Referrals/Authorization drop-down menu at the top.
  • Fill in all required fields.
  • Click Submit.

For more information

  • By mid-August, you'll be able to download an e-referral user guide with detailed information about e-referrals for Blue Cross Personal Choice PPO.
  • For more information about the product, see the article in the July – August issue of Hospital and Physician Update.
  • If you have any additional questions, contact your provider consultant.

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 CPT codes, descriptions and two-digit numeric modifiers only are copyright 2015 American Medical Association. All rights reserved.
Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and
independent licensees of the Blue Cross and Blue Shield Association.