Payer Policy Alignment Tables – Tools for Practices and POs
When payers align on common policies that promote high-quality primary care, administrative burden on practices is decreased and attention and time for patient care is increased. The MMI participating payers (BCBSM, Priority Health, HAP and MDHHS) have worked to better align policies, metrics, and requirements.
As tools to aid in the important work of practices and physician organizations in Michigan, MMI and its participating payers have worked to create comparative tables for social care (SDoH) and telehealth approaches across payers. There are many components for which policies have been aligned and others where we continue to work toward a common approach. The tables are not a replacement for detailed billing guidelines and requirements but are intended as user-friendly tools for practice teams that provide high-level overviews.
Michigan Medicaid Care Management Comparative Payer Policy Grid – The Michigan Medicaid Care Management Comparative guide is meant as a resource to practices regarding the general framework of Medicaid plan care management payer policies. It is not a substitute for detailed payer coding and billing requirements. The guide will be updated on an annual basis.
Social Care (Social Determinants of Health) – The Social Care policy table focuses on the approaches that plans use to reward practices and POs for screening and health exchange use case participation. The table will be updated annually with updates published in January.
HIE Incentives Table ‐ February 2024
Payer HIE incentives encourage providers to participate in use cases to support clinical decision‐making and the management of population health. Michigan Multipayer Initiatives (MMI) and MiHIN jointly work to support collaboration among Payers to better prioritize and align provider incentives related to Health Information Exchange (HIE), use case participation, and data‐sharing. This table will also contribute to MDHHS HIT 2023 Recommendation #2 (create multipayer HIE incentive inventory) aligned with the MI HIT Roadmap. Annual updating will occur each December.
Telehealth – The telehealth policy table features highlights of payer policies for key areas like audio-only coverage and site of care. The table will be updated quarterly.
NEW Collaborative Care Multipayer Policy Grid Released – To ease the path to understanding requirements and coding related to collaborative care, MMI has produced a new tool to make it easier for practices to partner PCPs with behavioral health professionals. You will see that the MMI Participating Payers (BCBSM, Priority Health, HAP and MDHSS) have worked to align policies wherever possible to ease practice administrative burden. All of the payers use the Washington AIMS Model as a basis for policies and requirements. Collaborative Care (CoCare) implementation has expanded across the state in the last few years and the grid is intended to serve as a helpful tool for those who have already begun implementation and for those interested in learning more.
We are working on developing tables for additional areas and will post them as they are completed.
Michigan Multipayer Initiatives 