Bcbsm mipct member lists webinar
This presentation is the property of its rightful owner.
Sponsored Links
1 / 8

BCBSM MiPCT Member Lists: Webinar PowerPoint PPT Presentation


  • 86 Views
  • Uploaded on
  • Presentation posted in: General

BCBSM MiPCT Member Lists: Webinar. 7/24/12 and 7/26/12. What is the member l ist?. Sent monthly to POs POs will receive email each month once list is available in their EDDI folders

Download Presentation

BCBSM MiPCT Member Lists: Webinar

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Bcbsm mipct member lists webinar

BCBSM MiPCT Member Lists: Webinar

7/24/12 and7/26/12


What is the member l ist

What is the memberlist?

  • Sent monthly to POs

    • POs will receive email each month once list is available in their EDDI folders

    • POs are responsible for distributing to all care managers working in participating practices as soon as possible

  • Patients on list are eligible for care management and are attributed to a MiPCT Physician based on BCBSM data.

    • List is “source of truth.” If a patient is included on the monthly list, practice unit staff can assume the patient has BlueHealthConnection, is part of a participating employer group, and is eligible to receive care management services.

    • If patient is not on list, cannot assume they will be eligible for care management services in the future

    • List is relatively stable and should not change that much from month-to-month. May see more movement in the 1st quarter of every year due to the renewal process


M ember list cont d

Member List, cont’d.

  • Note: Practice encouraged to use Web-DENIS or CAREN to check patient has active BCBSM coverage before delivering care.

  • Once POs have distributed the list of eligible patients to participating practices, the practices will review the list.

    • BCBSM is exploring ways to sort list prior to sending to POs. For more info on this or to provide feedback, please see the 7/23/12 edition of MiPCT Flash

  • List includes information about patients’ health status and recent health care use, such as emergency department visits

    • These data “flags” are used to indicate pertinent patient data

    • “Flags” of interest may include “high_deduct_plan” and “pharm_specialty,” e.g.

    • For more info, refer to data dictionary


Member list cont d

Member List, cont’d.

  • List should be used in conjunction with the provider’s clinical information and knowledge of the patient to decide who should be offered care management.

    • Patients will be contacted by the practice to initiate care management process once they are determined to be eligible and a suitable candidate for outreach

  • Currently exploring possibility of Michigan Data Collaborative distributing all member lists for MiPCT by end of 2012; more info coming soon!


Where does member list data come from

Where does member list data come from?

  • The information in the list is based on BCBSM’s Care Relationship algorithm.

    • Based upon a review of claims for eligible Blue Cross Blue Shield of Michigan members (“rendering provider” field is used)

    • Claims taken from an outpatient hospital or office setting with dates of service within the past 2 years (using a 2 month run out).

    • Filtered by specific procedure codes:

      • Base evaluation and management services, or

      • New procedure codes for preventive counseling, immunizations or consultations.


Resources

Resources

  • The following documents are available on the MiPCT web site: http://mipctdemo.wordpress.com/

    • Data dictionaries for both Commercial and MA populations

    • A “Frequently Asked Questions” document

    • Instructions for importing the patient lists


Member list demo

MemberList Demo

  • Now we will go step-by-step through opening and using the patient lists …


Bcbsm mipct member lists webinar

Questions??


  • Login