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Blue plans to offer Coordination of Care program
December 20, 2019

This article is for providers caring for other Blue plans’ Medicare Advantage PPO members who live Massachusetts.

On January 1, 2020, Blue plans nationwide will work together to launch the Blue Cross Blue Shield Coordination of CareSM program to maximize the quality of care our Medicare Advantage PPO members receive.

As a part of this program, we will work with you to support Medicare Advantage PPO members who live in Massachusetts and receive care from a Massachusetts provider, but have coverage through another Blue plan.

What are some of the changes you can expect to see as a result of this program?

We plan to offer more information about potential gaps in care and may request additional medical records so that other Blue plans can get a complete understanding of their member’s health.

Blue Cross Blue Shield of Massachusetts will do outreach for any information needed about members of other Blue plans. You will not need to be in contact with any Blue Plan that you are not contracted with to close care gaps or submit medical records.

Will our practice receive more medical record requests?

We know that you may sometimes receive record requests from different parts of our organization. We try to streamline these requests, but it is not always possible due to different reporting requirements. Please be mindful that your provider agreement requires you to respond to medical record requests you receive from us.

How can I identify members in this program?

Members in this program will have the following logo on their ID cards:

Questions?

If you have any questions, please contact Risk Adjustment at 1-617-246-3059. As always, thank you for the care you provide to our members.

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