Blue Cross Blue Shield of Michigan Provider-Delivered Care Management
Provider-Delivered Care Management (PDCM) is part of Blue Cross Blue Shield of Michigan’s Patient-Centered Medical Home program, which is a core element of Value Partnerships’ Physician Group Incentive Program.
Provider-Delivered Care Management involves the delivery of care management services by a care manager working with a physician and care team in an eligible primary care or specialist office.
All Blue Cross PCMH-designated physicians are eligible to bill Blue Cross for PDCM services, as well as non-designated practices participating in the Comprehensive Primary Care Plus (CPC+) initiative. Providers who participate in PDCM receive reimbursement for care management services rendered through 12 procedure codes, and primary care practices that meet Blue Cross claims criteria, and staffing/training criteria, will become eligible for the PDCM value-based reimbursement beginning July 1 of each year. Non-designated primary care physicians in the CPC+ program can bill PDCM; however, they are not eligible to receive PDCM value-based reimbursement. Eligibility for PDCM value-based reimbursement is re-evaluated annually.
There are different requirements to bill the codes than there are to receive the value-based reimbursement. For details about program criteria and requirements at each level of participation, please see the PDCM Frequently Asked Questions document, available by emailing firstname.lastname@example.org.
Summary of BCBSM PDCM programs and the care management training criteria is identified in the table below. For details about the criteria to participate in the PDCM programs, please see the PDCM Frequently Asked Questions document, available by emailing email@example.com.
For more information on CPC+ please refer to the BCBSM CPC+ FAQ
For more information on PDCM please refer to the BCBSM PDCM FAQ
Note: For Care Management Billing Resources Click Here.
For questions regarding courses or for additional information, please contact firstname.lastname@example.org