The guidelines are measured bi-annually and are used as benchmarks in helping SecureCare determine your provider status within the Blue Cross Blue Shield of MN network. This status determines your ability to stay in the network.
Depending on the policy type (Commercial, Medicaid and/or Medicare), benchmarks are based on average allowed dollars per patient, average number of services per visit and average number of patient visits annually.
Providers who fail to meet the benchmarks, based on their overall average, are identified as “Outliers”. SecureCare states that “Outliers” will be subject to medical records reviews and corrective action plans in order to maintain in-network status.
Please be sure to watch for your notification!
Update: On May 21, 2021, SecureCare emailed an updated version of the Clinical Review Guidelines for Blue Cross and Blue Shield of Minnesota (BCBSMN) Commercial plans. We believe these revisions simplify our clinical review requirements for clinics. However, questions have arisen regarding the $500 allowed dollars-per-patient clinical benchmark for BCBSMN Commercial claims. We hope the following explanation will offer more clarity.
The $500 per-patient commercial benchmark is an average of all commercial patient seen by a clinic over the course of a 12-month period. It is not a “per-patient” cap. This benchmark allows clinics more flexibility in delivering medically appropriate care based on patient needs. Some patients require a lower number of services but longer plan of care, while other patients require a higher number of services and a shorter plan of care. Only clinics exceeding this $500 per-patient average will be required to undergo medical record reviews. The SecureCare Provider Portal is updated monthly allowing you the opportunity to review not only your clinic data but also your peer averages. Be sure to visit your secure online provider portal at: www.securecarecorp.com.
SecureCare assumed responsibility of BCBSMN chiropractic network management on October 1st, 2016. In the years since, chiropractic clinics received two fee schedule increases, the ability to bill for CPT code 97140, and the removal of prior authorizations. In addition, this past January, a re-tiering of the network occurred affording 50% of network clinics an improvement in their tier position.
SecureCare is proud of its accomplishments and of its relationship with both the provider community and with. SecureCare continues to work for the advancement of chiropractic in Minnesota while creating a unified voice for all conservative care providers across the country. If you have any additional question, contact email@example.com.