August 2013
Changes coming as Blue Cross Blue Shield of Michigan transitions to nonprofit mutual
As we told you about earlier this year, Gov. Rick Snyder signed Public Acts 4 and 5, the acts that enable BCBSM to begin its transition to become a nonprofit mutual insurer. During this process, we promised our health care providers that we would keep them informed of progress and any changes that could occur as a result of the transition.
Progress to date
- The transition is ongoing throughout 2013, and BCBSM will complete the transition by Jan. 1, 2014.
- The process of creating a new company and governance is being led by BCBSM’s board of directors.
- Internal teams are reviewing the Michigan Insurance Code, which will regulate us moving forward (like all other insurers in Michigan).
- Operational and business changes to operate as a nonprofit mutual company are under way and minimal.
What isn’t changing
- Our current health care coverage for your Blue Cross patients and our ongoing partnerships with physicians and hospitals to improve the quality of care
- Our core values as a nonprofit with a deep commitment to Michigan and our customers
- Our contributions to building a healthier future for Michigan
What will be different
- Provider class plans and their annual reporting will no longer be required.
- BCBSM will continue to contract, set fees and policies, and regularly review performance based on provider groupings and types.
- This is similar to the provider classes established through the Public Act 350.
- Some of our contracts include language regarding provider appeals under PA 350, and this will change.
- The appeals process
A closer look at the appeals process
- Under the Michigan Insurance Code, the Department of Insurance and Financial Services will no longer review provider appeals for audit and post-service claim determinations.
- In order to be compliant with the insurance code, the BCBSM appeals process no longer includes DIFS.
- The proposed process replaces DIFS or binding arbitration with an external peer review by an independent review organization for non-policy (medical or clinical) issues.
- The results of the external peer review will be binding on both parties.
- All providers will continue to have access to their current internal appeal process.
These changes will continue to be communicated in The Record and on web-DENIS, but they must be reviewed and approved through our board of directors. As a result, we will publish an official notification of changes in the October issue of The Record.
If you have any questions, please contact your provider consultant.
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