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March 2017
Here’s what you need to know about Blue Distinction Total Care
In previous articles and other communications, we’ve told you about Blue Distinction Total Care, a Blue Cross and Blue Shield Association program. We’d like to provide a brief refresher, highlighting what you need to know.
- Blue Distinction Total Care is a national program that connects members of out-of-state Blue plans with health care providers in our Patient-Centered Medical Home and Organized Systems of Care programs. Also, Blue Cross Blue Shield of Michigan members who reside outside of Michigan are connected to high-quality health care providers in other states.
- Michigan physicians who have PCMH designation or who participate in our OSC program are considered Blue Distinction Total Care providers.
- We help steer members to BDTC doctors through our Find a Doctor search tool on bcbsm.com.
What do Patient-Centered Medical Homes and Organized Systems of Care need to know?
Patient-Centered Medical Homes |
Organized Systems of Care |
Only PCMH-designated physicians are reimbursed for care coordination services for eligible patients through the existing provider-delivered care management program. |
Practices that are part of an Organized System of Care — even if they aren’t designated as Patient-Centered Medical Homes — are considered Blue Distinction Total Care providers. |
PCMH-designated physicians will receive patient lists that include attributed host plan members who are BDTC-eligible. In the near future, PCMH-designated physicians will also receive clinical data for members of an out-of-state Blue plan, enabling them to better track their care. |
OSC specialists and OSC primary care physicians who aren’t patient-centered medical home designated are not eligible to bill for provider-delivered care management services. |
How does Blue Distinction Total Care work for different provider types?
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PCMH-designated primary care doctors |
Non-PCMH-designated primary care doctors in OSCs |
Specialists in OSCs |
Will be identified as BDTC provider in “Find a Doctor”? |
Yes |
Yes |
Yes |
Can bill PDCM codes for attributed members? |
Yes |
No |
No** |
Will receive patient lists that include attributed host plan members who are BDTC-eligible? |
Yes. These lists are the same as your monthly patient lists, only they now include hosted members. |
No |
No |
Will receive clinical data for members of an out-of-state Blue Cross plan, enabling them to better track their care? |
This data is being developed this year to be included in patient lists. |
No |
No |
**Note: Some specialty types will be eligible to bill for PDCM services as part of the PDCM specialty program, starting July 1, 2017. Send an email to valuepartnerships@bcbsm.com for more information.
Future Blue Cross plans include products that will steer members to BDTC providers through new products for national PPO customer groups. We expect these products to be available in 2018 and 2019.
For more information
For more information, physicians can contact their physician organization administrators. If you have a specific question and don’t have access to the Physician Group Incentive Program Collaboration site, email your questions to valuepartnerships@bcbsm.com.
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