MPTA leaders met with BCBSM on March 13 regarding the eviCore Utilization Management Program currently in use with the Medicare Plus Blue product. MPTA represented the NUMEROUS concerns expressed by providers and patients alike.
BCBSM stated that the implementation date of the eviCore program for its commercial products will be delayed until January 2018. MPTA will continue to push for substantial changes to the current program in the short term, and ultimately for its elimination.
The MPTA Patient Action Center portal is now available! This portal will allow patients to quickly and easily write letters to BCBSM about their negative experiences. CLICK HERE to access the portal.
If your patients experience delays or other barriers to necessary care because of eviCore, they should be encouraged to call the number on the back of their ID card. If the BCBSM Customer Service Representative determines it is a complaint/grievance, they will forward it according to BCBSM procedures.
You should also encourage them to access the MPTA Patient Advocacy Action Center portal. This will allow patients to use a template letter or customize their own letter, and will allow us to track the scope and extent of the problem. BCBSM may follow-up with patients about their experiences, so please prepare them for that possibility and encourage them to freely share their frustrations.
MPTA is especially concerned about the potential for errant determinations of medical necessity by eviCore, who is required to ensure their determination is consistent with general Medicare standards. According to BCBSM: “If at any time there is a dispute with the meeting of medical necessary, the provider can always request an appeal; for pre-auth the appeal goes to the MA PPO area for appeals at BCBSM and will be reviewed in full.” Please email email@example.com to let us know how frequently you are using this appeals process and whether you feel it is timely and effective.
Please also contact MPTA if you are experiencing problems with your Provider Category (A, B, or C). We have heard from members who have been mis-categorized and are being subject to unnecessary procedures with eviCore.
At the February 11 Western District meeting a financial advisor provided information about student loans and how to manage them once employed. The presentation can be viewed by clicking here.
Eastern District PT Pub Night is the 3rd Thursday of the month, rotating location