If you have not already, you should be receiving an email from SecureCare notifying you of your report card status.

As a reminder, SecureCare is the third party company partnered with BCBS of MN. One of their responsibilities is to monitor the statistics of each provider to ensure they are meeting the required benchmarks as determined by SecureCare. These statistics determine what tier status each provider is, which in turn determines their fee schedule for reimbursement. They also determine whether or not you continue to qualify to be an in-network provider with BCBS of MN.

Effective October 1, 2016, SecureCare began their stat tracking through Infinedi clearinghouse (your clearinghouse for electronic claims submission). Each month you will receive an updated report card (see below).

Report Card

This reports indicates:

  • Current stats for the prior month (under the provider column for individual doctors and the practice column for the clinic as a whole).
  • Your average stats based on a 12-month rolling period. (This means your November 2016 report card would include November 2015-October 2016 and then your December 2016 would roll to include December 2015 – November 2016 and so on.)
  • The report card will always indicate your Benchmarks. This number is the pre-set number determined for all BCBS of MN providers. These are the numbers you are trying to stay below in order remain an in-network provider with BCBS of MN.
  • Your report will give you your stats each month, but will also color code your information to help you know where you stand at a glance using green, yellow and red as the indicating colors.

Some things to note:

  • SecureCare only uses the Services Per Visit and Visits Per Patient stats in order to determine your network status. The Allowed $ Per Visit and Allowed $ Per Patient stats are strictly informational at this point.
  • Though you will receive a monthly update to your report card, SecureCare only evaluates your stats every 6 months (April & October). Because each month is based on a rolling average, your should not see a great variance in your numbers from month-to-month on your report card.
  • If you are a multi-doctor facility, SecureCare will send you individual doctor stats as well as the clinic stats each month. For network determination, SecureCare will use the clinic stats to determine if you are meeting the benchmarks and will evaluate the clinic as a whole, not each individual doctor when deciding if disciplinary action is necessary (such as a warning period or removal from the network).
  • As a Money Tree client, we do not have access to your report card. If you want us to view your report card and discuss your stats with you, we will be happy to do that once you forward us your username/password information.
Tagged with:  

Leave a Reply

Your email address will not be published. Required fields are marked *

You may use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <strike> <strong>