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.
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.
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.
We are working on developing tables for additional areas and will post them as they are completed.