We’ll include behavioral health practitioners in our PPO retrospective review process, as of February 2020

Beginning February 2020, our PPO network management team will begin reviewing the practitioner retrospective practice profiles of behavioral health professionals. The network management team routinely monitors PPO network practitioners to evaluate practice patterns and ensure PPO utilization standards are met.

All providers contractually agree to provide PPO members with efficient, cost-effective care that meets current utilization standards. The network management team will evaluate practitioners against established demographic and utilization criteria, comparing the practitioner’s utilization history to that of their Michigan peers.

Blue Cross Blue Shield of Michigan will monitor utilization patterns with the understanding that the unique aspects of a practitioner’s individual practice may affect his or her ability to perform within the averages established by a practitioner’s peers.

A more detailed look at what’s involved with this process will be included in the January 2020 issue of The Record.