Reminder: Select 1 PO with affiliated medical care group to support all Blue Cross, BCN business

Before Jan. 1, 2026, each primary care provider must align with one physician organization and that PO’s affiliated medical care group. It’s important for primary care providers to receive support for all Blue Cross Blue Shield of Michigan and Blue Care Network lines of business in which they choose to participate.

This includes our commercial and Medicare Advantage plans.

We first told you about this in the July 2024 Record. Primary care providers who haven’t yet aligned their PO and medical care group affiliations are urged to do so now. Any changes must occur before Jan. 1, 2026. Once you align your PO and medical care group affiliations, you’ll benefit from reduced administrative work and have more time for patient care.

What primary care providers need to do

Review the list of POs and their corresponding medical care groups.

• If the primary care provider is already part of a PO and medical care group that align: You’ll see that both the PO and medical care group are listed on the same row on the last page in the above link. In this case, there’s no action needed. If you have any questions, contact your PO.

• If the primary care provider isn’t already part of a PO or medical care group:
• Review the list of POs and their corresponding medical care groups.
• Reach out to them to inquire about participation requirements, including the benefits and services they offer.

• If the primary care provider is with one PO for Blue Cross contracts and a medical care group that doesn’t align to that same PO for BCN contracts:
• You’ll see that the PO and medical care group are listed on different rows on the last page of this list.
• Determine which entity you’ll align with going forward.
• Talk to both entities to ensure you make an informed choice.

• If the primary care provider is in the Upper Peninsula and aligned with the Upper Peninsula Health Group as his or her PO: There’s no need to align with a BCN medical care group, because there currently isn’t a corresponding medical care group to the Upper Peninsula Health Group PO. 

Notes:

• A primary care provider can participate exclusively in the Blue Cross networks without aligning to a PO. However, we encourage primary care providers to join a PO to maximize value-based reimbursement, incentive opportunities and opportunities for a value-based contract. 
• In some cases, a primary care provider may be able to participate in the BCN and BCN Advantage℠ networks without aligning to a PO and medical care group entity. But participation is limited based on the needs of the network. We encourage primary care providers to join a PO and medical care group entity to benefit from incentives, value-based opportunities and administrative support.

For more information

Here’s where you can learn more:

• Read “Blue Cross and BCN align primary care provider contracting entities” in the May-June 2024 issue of Hospital and Physician Update.
• Contact your Blue Cross PO or BCN medical care group.
• Reach out to PO or medical care group contacts in the list of POs and their corresponding medical care group.