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BestPractice is an innovative payment program that rewards quality and efficiency in the management of your patients’ health. Watch the videos to learn about what it is, how it works, and understand payments, claim submission, and more.
For further details. call Provider Relations at, 1-(800)-666-4627
View individual chapters below:
1. BestPractice Introduction
Highmark Blue Cross Blue Shield of Western New York introduces BestPractice, the new patient-centered, population-based reimbursement program for primary care providers.
2. What is BestPractice?
Learn more about BestPractice including the per-member, per-month base rate dollar amount, and what will continue as fee-for-service payments and the capitated dollar amount.
3. How does BestPractice Work?
Learn about member attribution and how McKesson Risk Manager™ is used to identify your Blue Cross Blue Shield patient panel.
4. BestPractice Base Rate-Adjustment Factors
Understand how the per-member, per-month base rate is determined along with the member-level adjustment factors including the member risk score and market trends. The physician-level adjustment factor of quality based on HEDIS scores is also addressed.
5. BestPractice Efficiency
Starting in 2018, the physician-level adjustment factor of efficiency is taken into consideration. Learn the factors related to efficiency.
6. BestPractice Payments
BestPractice payments include a monthly capitation payment as well as weekly fee-for-service payments for select services.
7. BestPractice Claims Submission
Learn how claims submission to the highest level of specificity determines how members are attributed to your practice, member cost share, and quality metrics.
8. BestPractice Next Steps
Next steps include one-on-one meetings with Blue Cross Blue Shield representatives where you will learn about programs and resources to assist you with population management.