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

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