eviCore will no longer mail Practice Profile Summaries and category information for outpatient physical therapy services starting in July

Beginning with July 2021 data, eviCore will no longer mail paper copies of the Practice Profile Summary, which includes information about your assigned category, to health care providers. Instead, eviCore will post category updates on the first business day of February and August each year beginning in August 2021.

Follow these steps to access your Practice Profile Summary and obtain your category:

  1. Access eviCore's provider portal and select Practitioner Performance Summary from the main menu.
  2. You may be prompted to select the health plan (select either Blue Cross or BCN) and enter your NPI.
  3. Click on the View PPS button to review your PPS.
  4. To find out your assigned category, click on the UM Category tab in the top left corner.

If you believe there are circumstances adversely affecting your utilization data, you may still request reconsideration within 15 days of eviCore's notification. Initiate your reconsideration request within the UM Category window.

Additional information is available on the evicore.com website as follows:

  1. From the Implementation Resources page* of evicore.com, click on the Solution Resources tab.
  2. Click on Musculoskeletal.
  3. Click on Practitioner Performance Summary & Utilization Management Categories Training Presentation.

You can also contact Provider and Client Services at 1-800-646-0418 for more information.

*Clicking this link means that you're leaving the Blue Cross Blue Shield of Michigan and Blue Care Network website. While we recommend this site, we're not responsible for its content.

Posted: March 2021
Lines of business: Blue Cross Blue Shield of Michigan and Blue Care Network