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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

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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.


  • 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 …