Changes to all Blue Cross Blue Shield of Michigan practitioner participation agreements announced

We’re making changes to the amendment provisions for all Blue Cross professional practitioner agreements and the Blue Cross Medicare Advantage PPO agreement. Effective Jan. 1, 2020, in addition to the language currently in the amendment provisions, these provisions will also state the following.

Blue Cross professional practitioner agreements:

“Notwithstanding the foregoing, if PRACTITIONER is employed by a physician group, physician organization, hospital or system, or other such entity (generally “Entity”), then PRACTITIONER acknowledges that he/she has authorized and empowered Entity to contract on PRACTITIONER’s behalf and bind PRACTITIONER to the terms and conditions of any arrangement Entity may enter into with BCBSM. If PRACTITIONER is not employed but has otherwise confirmed to BCBSM his/her affiliation with an Entity through a signed affiliation attestation, then PRACTIONER acknowledges that he/she has read and agrees to be bound to the terms of said Entity’s arrangement with BCBSM. Whether employed or affiliated, as set for above, PRACTITIONER acknowledges and agrees that BCBSM may, without notice of any kind, modify the terms of this Agreement to the extent necessary to effectuate and operationalize the arrangement between Entity and BCBSM. Such modifications may include, but are not limited to, modification to fee schedules or rates, application of withholds on payments to PRACTITIONER, or modifications to incentive programs. If a conflict exists between this Agreement and an arrangement between BCBSM and the Entity, the arrangement between BCBSM and the Entity shall control for disputes arising thereunder.”

Blue Cross MA PPO agreement:

7.3 General Modifications. BCBSM may amend this Agreement by providing ninety (90) days prior notice, written or electronic, of such amendment. Electronic notice shall include, but not be limited to, publication on web-DENIS. Written notice may include publication in The Record. Provider’s signature is not required to make the amendment effective. However, should the Provider no longer wish to continue affiliation in the MA PPO Program because of an amendment, then Provider may terminate this Agreement by providing forty-five (45) days written notice to BCBSM except during the initial term of the Agreement.

Otherwise, this Agreement, or any part, article, section, Exhibit, or Attachment hereto, may be amended, altered, or modified only in writing as duly executed by both parties.

Notwithstanding the foregoing, if Provider is employed by a physician group, physician organization, hospital or system, or other such entity (generally “Entity”), then Provider acknowledges that he/she has authorized and empowered Entity to contract on Provider’s behalf and bind Provider to the terms and conditions of any arrangement Entity may enter into with BCBSM.  If Provider is not employed but has otherwise confirmed to BCBSM his/her affiliation with an Entity through a signed affiliation attestation, then Provider acknowledges that he/she has read and agrees to be bound to the terms of said Entity’s arrangement with BCBSM.  Whether employed or affiliated, as set for above, Provider acknowledges and agrees that BCBSM may, without notice of any kind, modify the terms of this Agreement to the extent necessary to effectuate and operationalize the arrangement between Entity and BCBSM, to the extent the terms of such modifications are in accordance with the Medicare Advantage program rules pertaining to physician incentive plans. Such modifications may include, but are not limited to, modification to fee schedules or rates, application of withholds on payments to Provider, or modifications to incentive programs. If a conflict exists between any provision of this Agreement and an arrangement between BCBSM and the Entity, the arrangement between BCBSM and the Entity shall control, except for such provisions of this Agreement which are required by Medicare Advantage program rules, regulations, or CMS sub-regulatory guidance, in which case such provisions of this Agreement shall control.