Blue Cross Blue Shield of Michigan and Blue Care Network are extending the Advantasure Provider Engagement Coordination (PEC) program to select commercial members who may have a diagnosis gap. The commercial PEC program runs from April 1 - Dec. 31, 2022, and is designed to:
- capture all conditions to ensure accurate risk scores for commercial patients.
- match patient health care needs with appropriate levels of care.
- help keep health care premiums low and expand coverage for patients.
Participating providers will receive $50 per commercial patient for every Clinical Documentation Improvement alert returned within two weeks of the date of service and at least one condition addressed by checking “Yes” or “No” along with an updated progress note. This incentive is paid once per member.
The commercial PEC program will have a separate incentive and won’t affect Medicare Advantage PEC program metrics or incentive. The incentive will be paid at the same time as the Medicare Advantage PEC program payment in July 2023.
The Physician Alliance is one of only a few physician organizations selected to participate in this program. Eligible practices received a letter from Blue Cross in spring 2022 that outlines this program in more detail.
Questions regarding this program should be directed to the practice's Blue Cross provider clinical consultant.
