Blue Cross physical therapy program expands

In partnership with eviCore healthcare, Blue Cross Blue Shield of Michigan is expanding its physical therapy use management program to include our Blue Cross Medicare Advantage PPO, Medicare Plus Blue^SM, in addition to Blue Cross commercial PPO.

The expansion is intended to improve patient care and manage utilization for the following Michigan provider types and services:

• Independent physical therapy
• Outpatient physical therapy
• Hospital outpatient physical therapy
• Occupational therapy

Speech and language pathology services will continue to be excluded. The program will provide category assignments based on risk adjusted visits per episode of care.

Category assignments
As previously announced in the June 2016 Record, beginning in September 2016, profile reports for category assignments will include physical therapy claims for Blue Cross Medicare Advantage PPO and Blue Cross commercial PPO plans.

• Category assignments are determined by 12 months of combined independent physical therapy and outpatient physical therapy claims data.
• Three category tiers — A, B or C — will continue being assigned to physical therapists.
• Independent occupational therapists will default to category B.
• Outpatient occupational therapists will default to the category of their facility.
• Hospital outpatient physical therapy will continue to be an independent categorization.

In late September or early October, eviCore will mail letters identifying your provider category based on your combined Medicare and commercial claims data. Physical therapists will continue to have the option to request a reconsideration of category status within 15 days from date of the category notification letter.

Preauthorization program
A preauthorization program is in development. Look for upcoming Record articles and web-DENIS messages for more detailed information about preauthorization requirements and seminars that will review all changes.