MPTA's Payment Committee is continually meeting with health care professionals and various insurance companies throughout the state of Michigan to keep our members notified of any changes coming and to advocate for our physical therapy professionals. As a benefit to our membership, MPTA members are notified immediately of any policy changes or deadlines to an insurance plan or group.
Not all Payment questions can be treated the same way. Please email firstname.lastname@example.org if you have a specific question as it relates to Payment.
New APTA Toolkit re: Utilization Managementposted: May 10, 2017
Go to the APTA website for this new resource:
Utilization Management Toolkit
This toolkit offers an overview of challenges and opportunities for PTs in the commercial sector, strategies to mitigate the current and future impacts of UM use, and ways to foster cooperation between providers and UM vendors so that both parties benefit.
BCBSM Delays Implementation of eviCore Utilization Management Program for Commercial Products Until Jan 2018posted: March 22, 2017
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 Advocacy Action Center Portal is now available!posted: February 07, 2017
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.
- MPTA Letter to Priority Health June 6, 2017
- MPTA Letter to BCBSM May 12, 2017
- BSBSM Minutes from Meeting March 13, 2017
- MPTA Letter to BCBSM March 13, 2017
- MPTA Letter to BCBSM October 17, 2016
- MPTA Letter to BCBSM June 23, 2016
Important Payment Resources
- Code of Federal Regulations
- State of Michigan:
- APTA Resources: