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June 2020

We’re revising our Participating Hospital Agreement

With input from the hospital industry and the Michigan Health & Hospital Association, Blue Cross Blue Shield of Michigan is in the process of updating its model Participating Hospital Agreement. Due to current events, this course of action could be subject to change.

The new PHA model will modernize contractual language, define processes and augment future efforts to address affordability issues.

PHA revisions include:

  • Eliminate Blue Cross interim payments for all hospitals.(See the third question on the frequently asked questions document, which we link to below.)
  • Eliminate the annual settlement process.
  • Streamline the appeals process.
  • Update the contract administration process.
  • Simplify Peer Group 5 administration.
  • Eliminate Exhibit B and references to reimbursement for hospitals in Peer Group 1 through 4.

How do I learn more about the PHA changes?
Refer to the FAQ document for additional information or contact your contracting team.

No portion of this publication may be copied without the express written permission of Blue Cross Blue Shield of Michigan, except that BCBSM participating health care providers may make copies for their personal use. In no event may any portion of this publication be copied or reprinted and used for commercial purposes by any party other than BCBSM.

*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2019 American Medical Association. All rights reserved.
Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and
independent licensees of the Blue Cross and Blue Shield Association.