Blue Cross of Alabama PPA Tool

Blue Cross of Alabama Physician Performance Assessment (PPA Tool) is a web-based application that provides reporting on a providers clinical effectiveness (quality) and cost-efficiency.  Using certain claims data, the clinical effectiveness evaluation is based on nationally adopted National Quality Forum (NQF) measures.  The cost efficiency uses a nationally recognized risk-adjusted episode grouping methodology.

  • Clinical Effectiveness (Quality)
    • National Quality Forum Measures
  • Clinical Efficiency
    • Nationally recognized risk-adjusted episode grouping method

The PPA Tool is now available at ProviderAccess, click Resources. Initially, ten specialties will be included in the PPA Tool and will be released in phases.  Phase 1 of the PPA includes provider specialties for Adult Primary Care (Family Practice, General Medicine, Geriatrics and Internal Medicine) and Pediatrics.

PPA is in conjunction with the Blue Cross Complete Picture of Health Documentation & Coding Improvement Initiative.

Some coding elements include:

  • Main reason for the episode of care
  • Specificity of coding coveys complexity – file diagnosis codes that are most specific up to the 5th digit that will explain the documented symptom or diagnosis documented in medical record
  • Document and submit codes on all co-existing, acute or chronic conditions
  • Document and submit codes on past conditions impacting clinical evaluation and treatment
  • All diagnoses reset on December 31.  Chronic conditions must be re-evaluated, documented and submitted every year.
  • File up to 12 diagnosis codes

Some elements to avoid:

  • Avoid probable, suspected, rule-out or working diagnosis
  • Do not code conditions that were previously treated and no longer exist.  (ICD9 diagnosis history codes V10-V19 may be used as secondary codes if the historical condition or family history has an impact on current care or influences treatment)

For more information visit:  BCBS AL ProviderAccess – PPA Tool

MediSYS PM has the ability to submit up to the recommended 12 diagnosis per claim.  In addition, MediSYS PM provides some helpful tools to reduce the number of non-specific diagnosis codes and to more easily identify the chronic conditions to consider including on the claim.

Contact Us to see how MediSYS tools assist with Blue Cross of Alabama Physician Performance Assessment.