Revised Participating Hospital Agreement takes effect July 1, 2021

Blue Cross Blue Shield of Michigan, with input from hospitals and the Michigan Health & Hospital Association, has been working over the past three years to update the Participating Hospital Agreement.

The Health Care Delivery Committee, a committee of the Blue Cross Blue Shield of Michigan Board of Directors, approved the Third Amended and Restated Participating Hospital Agreement earlier this year. A copy of the new PHA was sent to all participating hospitals, serving as the requisite notice of board approval by the committee and Blue Cross.  

It becomes effective on the first day of the participating hospitals’ fiscal year, beginning on or after July 1, 2021, or as otherwise set forth in an applicable Letter of Understanding.

The revisions to the PHA address the ever‑changing financial landscape of health care. The Third Amended and Restated PHA was designed to reduce the administrative burden on health care providers and foster more effective relationships between the hospitals and Blue Cross.

PHA revisions include, but are not limited to:

• Eliminating Blue Cross Interim Payments, or BIP, for all hospitals
• Eliminating the annual settlement process
• Streamlining the appeals process
• Updating the Contract Administration Process
• Simplifying Peer Group 5 administration
• Eliminating Exhibit B and references to reimbursement for Peer Group 1 through 4 hospitals

How do I learn more about the PHA changes?
Refer to the Frequently Asked Questions document for additional information or contact your contracting team:

• Mike Andreshak, director, at 313‑448‑3905 or MAndreshak@bcbsm.com   
• Lynda Cerutti, director, at 269‑321‑7680 or LCerutti@bcbsm.com
• Fred Schaal, director, at 810‑720‑8555 or FSchaal@bcbsm.com
• Kurt Prettenhofer, manager, at 313‑448‑5815 or KPrettenhofer@bcbsm.com
• Lauren Rossi, manager, at 313‑448‑6090 or LRossi2@bcbsm.com