Blue Physician Recognition

General Disclaimer

The Blue Physician Recognition (BPR) designation means the physician has demonstrated a commitment to delivering quality and patient-centered care by participating in local, national, and/or regional quality improvement program as determined by the local Blue Plan. The BPR Program does not serve as a measure of the quality of care provided by a physician, group and/or practice or whether the physician will meet your particular healthcare needs. Absence of a BPR icon does not mean the physician or practice is of low quality; it could simply mean that the physician or practice does not participate in a quality improvement program recognized by the local Blue Plan.

Local Program Description -

2015 Professional Provider Quality-Based Reimbursement Program

This program will offer an opportunity for eligible providers to earn Blue Physician Recognition and increased reimbursement based on a three-group approach with prerequisites for participation. This reimbursement will be in addition to the established Maximum Allowable Payments (MAPs) for 2016.

QBRP Participation Prerequisites

Providers must conduct business with BCBSKS electronically (i.e. turn off paper). Providers must submit all eligible claims electronically, accept electronic remittance advice documents, and receive all communications (newsletters, etc.) electronically.

Group A

Applies to all eligible contracting professional providers and to all eligible/ covered CPT codes (excludes Lab, Drugs, and Dental).

  • Electronic Self-Service – Providers must electronically obtain BCBSKS patient eligibility and benefit information and BCBSKS claims status information at least 60 percent of the time when compared to the provider's total number of queries to BCBSKS. BCBSKS will rely on internal data to determine which providers qualify. Providers that qualify for this incentive will receive an additional reimbursement for all services except for clinical lab, pharmacies and pharmaceuticals, and dental services. (2.5 percent)

Group B

Applies to all prescribing provider types (MD, DO, DPM, OD, PA, APRN) and to all eligible/covered CPT codes.

  • KHIE use – Use the Kansas Health Information Exchange (KHIE) through an approved Health Information Network. Providers must inquire at least 60 times per quarter. (2.5 percent)
  • Use of Electronic Prescriptions
    • Electronically access member benefit information for eligibility, formulary, and medication history a minimum of 90 times per quarter. (.75 percent)
    • Minimum generic prescribing of 75 percent for all BCBSKS members with a prescription drug benefit. (.75 percent)
  • Specialty Pharmacy Prescriber – Must have at least five specialty pharmacy prescriptions per quarter, and at least 50 percent of all specialty pharmacy prescriptions must be filled through Prime Specialty Pharmacy. (.75 percent)

Group C

Applies to primary care professionals and associated PAs and APRNs in the specialties of family practice, general practice, general internal medicine, and pediatrics. Only applies to covered E&M codes.

  • NCQA Diabetes Recognition Program – Receive NCQA recognition for the Diabetes Recognition Program. (.75 percent)
  • PCMH recognition – Achieve NCQA and/or URAC Patient-Centered Medical Home (PCMH) recognition.
    • Level 1 or Level 2 (.75 percent)
    • Level 3 (1.75 percent)
  • MMR – Percentage of children who had one measles, mumps, and rubella (MMR) vaccine by their second birthday (turned age 2 in 2013). Must be equal to or greater than 60 percent. (.75 percent)
  • Immunization Outcome Measure for Tdap – The percentage of adolescents 13 years of age (turned age 13 in 2013) who had a Tdap vaccine by their 13th birthday. Must be equal to or greater than 70 percent to meet metric. (.75 percent)
  • Breast cancer screening – The percentage of women 50-74 years of age (52-74 as of December 31, 2013) who had a mammogram anytime on or between October 1, 2011 and December 31, 2013. Must be equal to or greater than 60 percent to meet the metric. (.75 percent)
  • NCQA Heart Stroke Recognition Program – Receive recognition from NCQA for the heart stroke program (.75 percent)
  • LDL Screening: Diabetes – The percentage of members 18-75 years of age with diabetes (type 1 or type 2) who had an LDL-C screening performed during the measurement year (calendar year 2013). Must be equal to or greater than 70 percent. (.75 percent)