This page contains educational resources to help ensure your success as a provider with Blue Shield's Primary Care Reimagined program.

Topics:
Primary Care Reimagined program overview
Value-based reporting platform training
Performance measures and coding support
Per member per month (PMPM) payment codes

Primary Care Reimagined program overview

Primary Care Pay-for-Value Hybrid Payment Model Manual (2021)

This comprehensive manual explains value-based care and the pay-for-value hybrid payment model using simple graphics and examples. You may review this manual in its entirety or use the clickable table of contents to navigate to the content you need.
Provider manual (PDF, 13.6 MB)
Primary Care Reimagined At-A-Glance Infographic (PDF, 7.6 MB)

Primary Care Reimagined: Hybrid Payment Model webinar (2022)

This webinar provides a deep dive into the Primary Care Reimagined hybrid payment model and an overview of the program.
Recorded webinar (40 mins)
Presentation (PDF, 1 MB)

Primary Care Reimagined: Contacts list

Program contact list (PDF, 53 KB)

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Value-based reporting platform training

Value-Based Reporting User Guide

The Value-Based Reporting platform is a flexible, user-friendly data interface designed to help you optimize patient care and track financial and quality progress. This user guide provides step-by-step instructions for using the platform. You may review the guide in its entirety or click the links in the table of contents to go directly to the information you need..
User Guide (PDF, 2 MB)

Value-Based Reporting tutorials

Watch these videos to learn how to track progress to goals and generate reports from the Value-Based Reporting platform.
Performance overview and navigation (4 mins)
Member attribution reporting (11 mins)
Financial reporting (5 mins)
Performance incentives reporting (11 mins)

Primary Care Hybrid Model Value-Based Reporting FAQ

This document provides answers to basic questions about the Primary Care Hybrid Payment Model Value-Based Reporting tool. Use the table of contents to navigate directly to the information you need.
FAQ (PDF, 62.4 MB)

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Performance measures and coding support

HEDIS Performance Measures Toolkit

This toolkit provides an overview of HEDIS along with descriptions of each key measure, and guidance on how to code appropriately so that your practice receives full credit for measure performance.

Coming soon: 2022 HEDIS Toolkit

HEDIS Supplemental Data Submission Requirements

Additional HEDIS clinical data about a member, beyond claims data, and information received by a health plan are considered supplemental data. This data is used to close care gaps and give practices credit for the care provided to members. Example: use of procedure codes for reporting a clinical result, such as cancer screening results or immunizations.

Coming soon: 2022 HEDIS Supplemental Data

Coding Tip Sheets

These tip sheets provide information about how to code appropriately so your practice receives credit for the work you do to improve patients' health and meet HEDIS measure requirements.
Controlling High Blood Pressure Coding Tip Sheet (PDF, 36 KB)
Diabetes Poor Control Coding Tip Sheet (PDF, 44 KB)

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PMPM payment codes

Procedure codes: Inclusions and Exclusions

This document provides a list of procedure codes in numeric order and their respective payment type. Codes not listed will be paid fee-for-service (FFS). Use F3 on your keyboard to search the document.
Primary Care Reimagined Procedure Codes (PDF, 3.7 MB)

 

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