Attribution will be expanded to advanced practice providers in April

Starting in April, physician organizations and Blueprint risk-bearing contracted entities will be able to align advanced practice health care providers (certified nurse practitioners and physician assistants) to their provider entities through the Provider Enrollment and Change Self-Service tool in our provider portal (availity.com).**

To access the Provider Enrollment and Change Self-Service tool in our provider portal:

1. Log in to availity.com.**
2. Under Payer Spaces, click on the BCBSM and BCN logo.
3. Click on the Applications tab.
4. Scroll down and then click on the tile for Provider Enrollment and Change Self-Service.

Note: Users need to be registered in one of the following roles to access the tool:

• Provider data management
• Provider enrollment and contracting

Advanced practice providers can identify as primary care providers

Advanced practice providers will also be able to identify as primary care providers for our Blue Cross Blue Shield of Michigan commercial PPO and Medicare Plus BlueSM PPO products during enrollment, which will allow them to be included in Blue Cross’ primary care attribution process used by our Physician Group Incentive Program, Blueprint and other provider value-based programs. Details on advanced practice provider opportunities in our provider value-based programs will be announced at a later date.

When eligible certified nurse practitioners or physician assistants choose to enroll as primary care providers, this will enable Blue Cross members to search for them as primary care providers on the Find a Doctor directory on bcbsm.com. Eligible CNP primary care provider specialties for Blue Cross PPO and Medicare Plus Blue PPO include:

• Acute care nurse practitioner
• Adult care nurse practitioner
• Certified nurse practitioner
• Family nurse practitioner
• Adult care nurse practitioner
• Pediatric nurse practitioner
• Gerontology 

Physician assistants will be considered primary care providers based on the specialty of their supervising physicians (also known as the participating physicians) during enrollment. The participating physicians must be M.D.s or D.O.s, actively enrolled with Blue Cross, and fully credentialed and in good standing with the company. Non-Blue Cross M.D.s and D.O.s, or those with an active disciplinary status, can’t be the participating physicians for physician assistants. Eligible physician subspecialties include:

• Adolescent medicine
• Family practice (medicine)
• Family medicine and osteopathic manipulative therapy, or OMT
• General practice
• Geriatric practice
• Internal medicine
• Pediatrics
• Preventive medicine
• Public, health, general

Participating physician data maintenance (for example, changing participating physician) will be managed through the same process used for all other practitioner demographic changes. Physician assistant primary care provider eligibility will be limited to Blue Cross PPO and Medicare Plus Blue PPO at this time. PAs will be eligible to be Blue Care Network primary care providers at a future date to be determined.

CNPs and PAs identified as primary care providers will be included in our primary care member attribution process for Blue Cross PPO and Medicare Plus Blue PPO. M.D.s and D.O.s will take precedence over the CNPs and PAs in the attribution algorithm. A CNP or PA will never reduce M.D. or D.O. attribution. CNPs and PAs will only receive attributed members when those members haven’t seen an M.D. or D.O. primary care provider for at least 24 months.

Contact Provider Inquiry if you have any questions related to advanced practice providers’ primary care provider eligibility or member attribution implications.

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

Availity^® is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to offer provider portal and electronic data interchange services.

Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association.