Overview of care management and utilization management programs now available
Blue Cross Blue Shield of Michigan and Blue Care Network have implemented many care management programs for members and utilization management programs for providers.
- Care management programs provide patient support by identifying patients with health risks and working with them to improve or maintain their health.
- Utilization management programs focus on ensuring that patients get the right care at the right time in the right location through the authorization process.
These programs vary based on member coverage and may be administered by Blue Cross or BCN staff or by contracted vendors.
We recently published the Care management and utilization management programs: Overview for providers document to help you navigate these programs. This information may help you to identify services that could be useful to your patients or to learn more about programs in which your patients are participating.
In the overview document, we've:
- Categorized the programs and the services for which we have care management and utilization management programs
- Listed who provides services within each category (Blue Cross or BCN staff, contracted vendors or both)
- Indicated whether services are available to Blue Cross commercial,Medicare Plus BlueSM, BCN commercial or BCN AdvantageSM members.
To see more detail about the programs, click a category heading. A document will open that provides:
- A summary of available services
- The groups and individual members to which services are available
- Resources for finding more information
You can access the overview document by going to ereferrals.bcbsm.com, clicking the Quick Guides link (under Additional Resources) and then clicking the Care management and utilization management programs: Overview for providerslink.
We announced the publication of the Care management and utilization management programs: Overview for providers document in the December 2021 issue of The Record. We'll also report it in the January-February 2022 issue of BCN Provider News.
Posted: December 2021
Lines of business: Blue Cross Blue Shield of Michigan and Blue Care Network