Blue Links for Employers

PPO Member Attribution and Billing

We're committed to providing your employees access to the best health care possible. That's what led us to expand our industry-leading Alternative Quality Contract (AQC) payment model to our Preferred Provider Organization (PPO) members.

With this expansion, we're making efforts to improve the cost and quality of care for our members. This requires us to attribute your employees who are on a Blue Cross PPO plan to a health care provider who will act as a primary care provider (PCP) and be responsible for coordinating the patient's total care.

In the future, and continually as new health care provider groups are added or attribution changes, letters will be sent to notify your employees that they have been attributed to a health care provider in the network. Members outside Massachusetts would be attributed to the local Blue Plans' contracted and qualified health care providers and in-state members will receive the communication from us.

In March, our mailing will include employees attributed to one of these five physician groups:

  • Lahey Health
  • Lowell General Hospital
  • Mount Auburn Cambridge Independent Practice Association and Mount Auburn Hospital
  • Partners Healthcare
  • Steward Health

The letter will inform your employees that we will begin sharing health information such as prescriptions and health care provider visits, with the attributed health care provider who will coordinate their care.

For self-insured accounts, your monthly invoices will reflect a per member per month cost for each employee attributed to an in-state or out-of-state provider who is covered by a value-based contract. The sum of in-state and out-of-state costs will be identified under the heading "Member Based Charge."

How Attribution Works
We determine member attribution by using claims data that includes identifying a consistent pattern of visits and prescriptions with a particular health care provider. If a member wants to make a change to a new or different PCP, they can do so easily by calling Member Service.

Attribution does not affect PPO coverage, and PPO members won't need a referral to see other health care providers, including specialists.

Our model provides a quality care advantage that has proven to reduce medical spending and improve health outcomes, which helps to strengthen your workforce and make health care more affordable for you. It's how we're driving health care to work better and leading the way to lower costs and better health.

If you have questions, please contact your account executive.

Blue Cross Blue Shield of Massachusetts

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