Initial Health Assessment process in HMO

Initial Health Assessment

As a Medicare Advantage Organization, BCBSF must make a reasonable effort to complete an initial health assessment for each BlueMedicare HMO, BlueMedicare PPO and BlueMedicare PFFS member within 90 days of enrollment to identify members with potential serious and/or complex medical conditions. BCBSF will notify the member’s in-network primary physician if:

* The member refuses the assessment.

* The member is placed in the high-risk category and the member consents to the release of the results.

Members with potential serious and/or complex medical conditions may be identified using one or several of the following methods:

*Daily hospital census

Concurrent reviews

Population assessments

Targeted illness management programs

Authorization process

Primary care physician (PCP)/primary physician chart reviews

Physician referrals to care coordination