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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.