Here’s what you need to know about SecureCare

In July 2022, Blue Cross Blue Shield of Michigan began working with SecureCare^®, an independent network performance management company, to manage the provider utilization process for:

• Independent physical therapists, or IPTs
• Outpatient physical therapy facilities, or OPTs
• Occupational therapists, or OTs
• Speech-language therapists, or STs
• Athletic trainers, or ATs
• Chiropractors

This management process program aims to obtain optimal outcomes for patients, while providing efficient, cost-effective care. Since the implementation of our collaboration with SecureCare, we’ve received some questions related to the program and wanted to provide the following information for clarification:

• SecureCare’s clinical review program manages clinics at the Group NPI level.
• The clinical benchmark isn’t a per-patient limit. Instead, it’s a rolling 12-month clinical average used to determine when to initiate a medical record review. SecureCare’s proprietary model uses historical claims data that compares clinics to their peers by line of business.
• SecureCare’s medical record review process ensures that medically necessary care is delivered. The medical record documentation, appropriate utilization of CPT codes, case management and the Blue Cross Blue Shield of Michigan online manual are considered in this determination.
• Members can’t be transitioned to self-pay for medically necessary services when benefits haven’t been exhausted.
• Contract benefits outline maximum allowable visits within a calendar year, but services must be deemed medically necessary.
• Providers are contractually obligated to comply with medical record requests from SecureCare and adhere to all quality and utilization standards, as well as the reimbursement policies and procedures of Blue Cross.

For more information

• Provider manuals are updated regularly, and providers should review these throughout the year to stay informed about program details.
• Additional resources and answers to frequently asked questions are available at securecarecorp.com.**

**Blue Cross Blue Shield of Michigan doesn’t own or control this website.