How We Choose Providers for Our PPO Networks

If you'd like more information about how we choose the doctors, hospitals and health care professionals for our networks, you can find that here.

Blue Cross Blue Shield of Michigan follows credentialing and quality standards set by the National Committee for Quality Assurance and the National Quality Forum when choosing providers to include in our PPO network. We also review their performance using measures from appropriate state and national accreditation guideline programs.

Doctors and hospitals don't have to take part in quality programs or meet specific measures for member service before joining our network. We make sure our members get the best care by offering incentives to our network providers for taking part in quality activities.

We require our network hospitals to participate in quality activities at least once every 18 months, including:

  • Leapfrog Hospital Survey
  • Joint Commission Periodic Performance Review of National Patient Safety Goals
  • Agency for Healthcare Research Patient Safety Indicators
  • Federally-Qualified Patient Safety Organization

We offer incentives to our network doctors and health care professionals for quality and efficiency performance in any of the following programs:

  • Patient-Centered Medical Home, or PCMH
  • Physician Group Incentive Program, or PGIP
  • Patient-Centered Medical Home - Neighbor

All these programs include measures related to preventive health, chronic conditions and member satisfaction.

Learn more about our PPO networks and how we select providers:

Our PPO networks contract with all hospitals in Michigan, including acute care and specialty hospitals. It has a large network of providers and hospitals within Michigan and includes nationwide coverage.

We monitor and update our providers every year. That way, we can ensure that our members have access to their doctors within a reasonable distance.

Regardless of the type of area they live in, at least 90 percent of our member population has to have access to a certain number of doctors within a certain time or distance from their home. The standard varies by specialty and type of area. For example, in a large metro area, members must have at least one primary care physician, or PCP, within 10 minutes or five miles from their home. In rural areas, the access standards for PCPs is 90 minutes or 75 miles.

PPO Access Standards for PCPs, Specialists and Hospitals (PDF) 

  • Medical Doctor, or MD (includes psychiatrist)
  • Doctor of Osteopathy, or DO (includes psychiatrist)
  • Doctor of Podiatric Medicine, or DPM
  • Doctor of Chiropractic, or DC
  • Oral Surgeon
  • Fully Licensed Psychologist (doctoral level)
  • Clinical Licensed Master’s Social Worker, or CLMSW
  • Licensed Professional Counselor, or LPC
  • Independent Occupational Therapist, or IOT
  • Independent Physical Therapist, or IPT
  • Independent Speech-Language Pathologist, or ISLP

A wide variety of specialists are also included. A specialist is a doctor who has advanced medical training in a specific area, such as children’s health or heart disease.

See How We Choose HMO Providers for information on how we choose providers for our HMO networks. 

Questions?

Privacy issues: To report a concern or if you think your protected health information has been compromised, please call us at 1-800-552-8278 or email us. Don't include any protected health information in your email. 

Other issues: For customer service, call the number on the back of your member ID card.