Overview of Hospital Settlement Changes Blue Cross Blue
Overview of Hospital Settlement Changes Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association.
Outline • Background - Hospital Settlement Modernization – Better data and more automated approach to producing a settlement • Need dynamic pricing capabilities as new products and reimbursement arrangements are developed – Improve provider satisfaction and simplify the settlement review/reconciliation – Minimize settlement and get closer to a pay to voucher process • New Claim and Line Level Pricing Process (CAL) - Pricing captured by claim and line in Access Database - Excel Summary (Cash Reconciliation) - Effective for all Peer Groups, beginning with 6/30/2015 settlements • Summary and Questions 2 Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association.
Front Sheet Report 3 Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association.
Front Sheet Claim Detail 4 Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association.
Old Cash Reconciliation 5 Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association.
CAL Settlement – Access Database 6 Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association.
Summary • Blue Cross is taking steps to reduce provider pain points and provide more usable data • Supports TCR (Transforming Contracting and Reimbursement) contracts - Emulate how claims are priced by the claim system - Limit reimbursement to charges - Settlement and vouchering rates are the same • We’re continuing to work on improving the quality of our data so stay tuned for future enhancments • Your feedback is welcomed! 7 Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association.
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