P
Sep 1, 2020

BCBSRI Advanced Primary Care Program policies

The BCBSRI Advanced Primary Care Program policies were updated on July 28, 2020 and communicated by email from pcmh@bcbsri.org. These policies are effective September 27, 2020, and outline the requirements and expectations of all PCMH practices. Adherence to these policies is required to be recognized as a PCMH provider by BCBSRI.

Specific changes and additions to this version of the policies include:

  • Nurse Care Manager/Care Coordinator (NCM/CC) recognition requirements and staffing notification process to BCBSRI
  • NCM/CC roles and responsibilities:
    • Key elements of care management defined by NCQA standards
    • Care management areas of focus
  • Performance guarantees
  • Reporting requirements
    • High-risk/high-cost care management
    • Chronic condition management
    • Wellness/prevention and social determinants of need
    • Patient experience
       
      Please direct any questions regarding these changes to pcmh@bcbsri.org. Thank you for your continued commitment to delivering high-quality care.