The BCBSRI Advanced Primary Care Program policies were updated on July 28, 2020 and communicated by email from pcmh@bcbsri.org. These policies are effective September 27, 2020, and outline the requirements and expectations of all PCMH practices. Adherence to these policies is required to be recognized as a PCMH provider by BCBSRI.

Specific changes and additions to this version of the policies include:

• Nurse Care Manager/Care Coordinator (NCM/CC) recognition requirements and staffing notification process to BCBSRI
• NCM/CC roles and responsibilities:
  • Key elements of care management defined by NCQA standards
  • Care management areas of focus
• Performance guarantees
• Reporting requirements
  • High-risk/high-cost care management
  • Chronic condition management
  • Wellness/prevention and social determinants of need
  • Patient experience
     
    Please direct any questions regarding these changes to pcmh@bcbsri.org. Thank you for your continued commitment to delivering high-quality care.