We’re amending all nonhospital provider agreements

To clearly align with the disclosure requirements of the Federal Consolidated Appropriations Act, Blue Cross Blue Shield of Michigan is making changes to provider information provisions in all nonhospital provider agreements. Effective Aug. 1, 2022, these provisions will be amended as follows:

Provider Information. Blue Cross Blue Shield of Michigan may disclose provider-specific information as follows:

a.   Pursuant to any federal, state or local statute or regulation, Blue Cross Blue Shield of Michigan and provider recognize that confidentiality does not apply in circumstances outlined in 42 USC 300gg-119, which requires that BCBSM be permitted to disclose the following information for any reason:

• Provider-specific cost or quality of care information through any means to referring providers, a plan sponsor, business associates, enrollees or individuals eligible to become enrollees under any plan or coverage

• Upon request, electronically accessible de-identified claims and encounter information or data for each enrollee in the plan or coverage, including financial information, provider information, service codes or any other data included in a claim or encounter transaction on a per claim basis

b.   To a customer for purpose of audit and health plan administration so long as the customer agrees to restrict its use of information to these purposes and agrees not to further disclose the information. Furthermore, this section shall not be construed to restrict Blue Cross Blue Shield of Michigan from sharing all such information with its subsidiaries.

c.    For purposes of public reporting of benchmarks in utilization management and quality assessment initiatives, including publication in databases for use with all consumer-driven health care product, or other similar Blue Cross Blue Shield business purposes; or
 
d.    For civil and criminal investigation, prosecution or litigation to the appropriate law enforcement authorities or in response to appropriate legal processes

e.    Furthermore, this section shall not be construed to restrict Blue Cross Blue Shield of Michigan from sharing all such information with any of its subsidiaries and affiliates.