Blue Cross Blue Shield of Michigan and Blue Care Network have contracted with Covera Health to launch a radiology-focused quality improvement program to help us better support radiologists and referring providers in their efforts to improve diagnostic quality, overall care and patient outcomes.
This email message includes important points for you to know and share with your physician offices. You can find additional information about this program on page 22 of the January-February issue of BCN Provider News or in the January issue of The Record.
Starting in April 2023, the program will be available for the following groups and members:
- BCN commercial — Members who have coverage through fully insured groups and members who have individual coverage
- BCN AdvantageSM — All groups and all members who have individual coverage
- Blue Cross commercial — Members who have coverage through fully insured groups and members who have individual coverage
- Medicare Plus BlueSM — All groups and all members who have individual coverage
Covera’s quality improvement programs support radiology facilities and radiologists in their efforts to:
- Engage in continuous quality improvement
- Identify peer learning opportunities
- Improve quality of care provided to patients
- Improve patient outcomes
Participating radiology facilities and radiologists will be eligible for a high-quality designation. This designation makes it easier for referring providers to refer patients to high-quality radiology centers, which can support improved patient outcomes.
Designations for quality and value
On prior authorization requests approved by AIM Specialty Health®, Covera designations will display as follows:
- For BCN commercial, BCN Advantage and Medicare Plus Blue members, facilities will be identified as having high-quality designations and will be listed as recommended providers.
- For Blue Cross commercial, facilities will be identified as having high-quality designations.
Providers that are designated as high quality and are also cost effective will receive an additional high-value designation on prior authorization requests approved by AIM. Cost efficiency is determined through cost factors including (but not limited to):
- The cost of the diagnostic service being requested
- The average cost of the service in the geographic area
If you have questions about this program, contact Covera Health by calling 1-855-211-2272 or by sending an email message to firstname.lastname@example.org.