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Patient attribution to primary care providers (PCPs)
The attribution process
The attribution process utilizes claims data, a frequently used methodology in value-based programs, because it standardizes PCP assignments.
BCBSND members will be attributed to a PCP by using the following process:
- 12 months of claims data is analyzed
- Members are assigned each reporting period
- The provider most likely responsible for the member's overall health care delivery during that period is assigned as the PCP
- Attributions are evaluated and updated on a monthly basis
PCP-eligible providers include physicians and mid-level practitioners in the following specialties:
- Internal medicine
- Family medicine
- Pediatrics
- General practice
- Primary care based NP & PA
- OB/GYN and Certified Nurse Midwives who practice in a primary care capacity
Example attribution scenario
Combined, Medical Group A billed the most evaluation and management (E&M) services (a total of eight), positioning it ahead of Medical Group B, which only billed a total of five E&M services.
Within Medical Group A, Dr. K. billed the most E&M services (a total of four) and is therefore assigned as the member's PCP.
