| Q: |
Is there a separate contract for physicians/professional providers to sign for the BlueChoice Solutions network? |
| A: |
No. The contract terms under your current BlueChoice Physician Agreement applies to BlueChoice Solutions.
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| Q: |
What are the credentialing factors mentioned in the BlueChoice Solutions notification letters? |
| A: |
Current BlueChoice credentialing standards, Risk Adjusted Cost Indices (RACI), Evidence Based Measures Indicators and screening of appropriateness of utilization or coding.
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| Q: |
How is an individual physician/professional provider selected as a participant in the BlueChoice Solutions network? |
| A: |
A physician’s/professional provider’s eligibility is based on:
- Current BlueChoice network status,
- Favorable overall Risk Adjusted Cost Index (RACI),
- Performance on Evidence Based Measures Indicators,
- Geoaccess needs,
- Utilization or coding that does not stand out from their peers, and
- Meets the minimum number of episodes
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| Q: |
How is a group of physicians/professional providers selected as a participant in the BlueChoice Solutions network? |
| A: |
Multi-specialty groups/Medical groups, for purposes of BlueChoice Solutions, are physicians/professional providers with a single tax identification number.
Eligibility is based on:
- Current BlueChoice network status,
- Favorable overall Risk Adjusted Cost Indices (RACI),
- Performance on Evidence Based Measures Indicators,
- GeoAccess needs,
- Utilization or coding that does not stand out from their peers, and
- Meets the minimum number of episodes
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| Q: |
Why were physicians/professional providers credentialed based on Tax ID group affiliation? |
| A: |
Physicians/professional providers are credentialed based on Tax ID group affiliation to eliminate the administrative issues that would occur if only some members of a single Tax ID group participated in the BlueChoice Solutions network.
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| Q: |
If a physician/professional provider does not have a group contract, then why was the physician/professional provider given a group score? |
| A: |
To eliminate the administrative issues that would occur if only some members of a single Tax ID physician group participated in the BlueChoice Solutions network.
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| Q: |
How will a physician/professional provider know if he/she is selected as a participant in the BlueChoice Solutions network? |
| A: |
The physician/professional provider or their Tax ID affiliated medical group will receive a letter advising that he/she has been selected to participate in the BlueChoice Solutions network.
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| Q: |
How will the physician/professional provider know if they are not selected as a participant in the BlueChoice Solutions network? |
| A: |
The physician/professional provider or their Tax ID affiliated medical group will receive a letter advising that based on credentialing criteria they are not eligible to participate in the BlueChoice Solutions network.
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| Q: |
If a physician/professional provider is not selected to participate in the BlueChoice Solutions network, when is the next opportunity for these physicians/professional providers to be reevaluated to participate in the BlueChoice Solutions network? |
| A: |
Physicians/professional providers that were not selected for participation in the BlueChoice Solutions network will be reevaluated annually.
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| Q: |
Can a physician/professional provider voluntarily terminate his/her participation in the BlueChoice Solutions network? |
| A: |
Physicians/professional providers have the option to not participate in the BlueChoice Solutions network. Opting out or voluntarily terminating from the BlueChoice Solutions network does not affect a physician’s/professional provider’s participation in the BlueChoice network.
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| Q: |
What happens if a physician/professional provider voluntarily terminates or BCBSTX terminates a physician’s/professional provider’s participation in the BlueChoice network? How will this affect a physician’s/professional provider’s BlueChoice Solutions participation? |
| A: |
Being in the BlueChoice network is a prerequisite for participation in the BlueChoice Solutions network. If a physician/professional provider voluntarily terminates or BCBSTX terminates a physician’s/professional provider’s participation in the BlueChoice network, this will also terminate the physician’s/professional provider’s participation in the BlueChoice Solutions network.
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| Q: |
Who should a physician/professional provider call to find out why he/she was not selected as a participant in the BlueChoice Solutions network? |
| A: |
Their local Professional Provider Network office.
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| Q: |
If a physician/professional provider is selected as a participant how is he/she going to be paid? |
| A: |
The fee allowables provided under the physician’s/professional provider's current BlueChoice Physician Agreement will also apply to the BlueChoice Solutions network.
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| Q: |
Will new physicians/professional providers right out of medical school be allowed in the BlueChoice Solutions network? |
| A: |
Physicians/professional providers starting to practice will be credentialed under the same guidelines as all other physicians/professional providers. The new physician/professional provider must meet the following eligibility criteria to receive an invitation to participate in the BlueChoice Solutions network:
- Current BlueChoice network status,
- Favorable overall Risk Adjusted Cost Indices (RACI),
- Performance on Evidence Based Measures Indicators,
- GeoAccess needs,
- Utilization or coding that does not stand out from their peers, and
- Meets the minimum number of episodes
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