BCBS Michigan

Overview

Michigan Blue plan with multiple sub-plans/LOBs. Blue Plus is the Medicare LOB; BCN (Blue Care Network) is a separate plan-set. Top-AR plan for Theoria (~$500K open).

Active Work / Processes

• Provider-by-provider review of LOB-level enrollments owned by Amanda Spadafora (Medallion specialist).
• Working session with BCBS-MI specialist + Lori (Theoria) + Carrie requested for week of 2026-04-22 (after Nicole returns 4/22).

Pain Points / Open Issues

• Blue Plus must be enrolled at individual (provider) level, not group — and rule changes by provider type (NP vs MD). Easy to miss.
• BCN is a separate plan-set that may not include Blue Plus — providers can be in-network on BCN but not on Blue Plus.
• Midwest H stalled — Svetlana characterized as “nothing done since December” through 4/14; Amy disputes “nothing” but agrees pace has been slow. New BCN contract Amanda submitted recently.
• Midwest M — progress in February then stalled.
• Southeast H — no records pulling up at all.
• Retroactive dates needed via Theoria, not complex care — some Blue Plus providers (e.g. LaDonna Peters) are in-network under complex care with 2026 dates of service, but billing is via Theoria so retro dates are still required.

Decisions & Commitments

• 2026-04-14 — Confirmed Blue Plus enrollments must be at individual level with NP-vs-MD distinction; Amanda Spadafora to verify each Theoria provider’s configuration. Source: Amy Barfield in 14 Cred Hold sync.
• 2026-04-17 — Working session with BCBS-MI specialist + Lori + Carrie targeted for week of 4/22. Source: Amy in 17 weekly sync.

Key Facts

• Blue Plus = Medicare LOB, individual-level enrollment required
• BCN is a separate plan-set (not automatically tied to Blue Plus)
• NP-vs-MD distinction affects enrollment configuration on Blue Plus
• Theoria top-6 AR providers (per Amy Barfield 4/14): LaDonna Peters, Patricia Blank, Miller, Claudia Romo, Ashley Poulos, Julie Tuffo, Melissa Miller

Related Customers

• Theoria Medical — ~$500K open AR; Midwest H, Midwest M, Southeast H all impacted

Source History

• 2026-04-13 — Theoria Monthly Product Sync — BCN-MI 4/1 contract not visible in Theoria’s LOB display (product-research example)
• 2026-04-14 — Theoria Cred Hold sync — top-6 AR providers, individual-level Blue Plus rule
• 2026-04-15 — Complex weekly sync — Midwest H “nothing done since December”; BCN February-Dec stall
• 2026-04-17 — Theoria weekly sync — working-session ask for week of 4/22