Update: Article on direct reimbursement to athletic trainers

In an article in the October Record, we stated that athletic trainers could receive reimbursement for physical medicine services for BCN Advantage℠ members. However, since the time of publication, the scope of this reimbursement program has changed. Athletic trainers can’t be reimbursed for physical medicine services for BCN Advantage members. Also, as a reminder, they can’t be reimbursed for services to Medicare Plus Blue℠ members. Use the following updated article as your reference on this topic.

Athletic trainers can receive direct reimbursement for physical medicine services for Blue Cross Blue Shield of Michigan’s commercial members in the Traditional and TRUST networks, as well as Blue Care Network commercial members, on or after Jan. 1, 2021. Direct reimbursement to athletic trainers for services to Medicare Plus Blue and BCN Advantage members is prohibited.

Athletic trainers can now apply to participate in Blue Cross’ commercial networks (Traditional and TRUST), as well as BCN’s commercial network. To apply, go to bcbsm.com/providers and click on Enroll to become a provider. Specific qualification requirements are identified within each agreement. All applicants to the Traditional, TRUST and BCN networks must pass a credentialing review before participation. We’ll notify applicants in writing of their approval status.

Participating athletic trainers will receive direct reimbursement for covered services within the scope of their licensure at 85% of the applicable fee schedule, minus any member deductibles and copayments. This change, effective for services provided on or after Jan. 1, affects Blue Cross and BCN plans that cover services these providers are licensed to provide. To find out if a patient has coverage, check web‑DENIS for member benefits and eligibility or call Provider Inquiry at 1‑800‑344‑8525.

Authorization requests for BCN members
For services provided to BCN commercial members, athletic trainers must submit authorization requests for physical medicine services to eviCore healthcare. There is no prior authorization required for Blue Cross commercial members.

About physical medicine benefits
Athletic trainers should tell members that the physical medicine services they provide count toward a member’s physical therapy benefits. Because physical therapy benefits are limited during a plan year, the physical medicine services provided by athletic trainers will reduce a member’s future benefits for that plan year.