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Scope of Service for Unlicensed Care Team Members
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View Scope of Service Sample

As a general PDCM guideline, all participants should operate within their scope of practice and clearly document services provided, including information to support the medical necessity of the service. This sample standing agreement may vary based upon organizational structure and can be used as a guide in developing the particular agreement for each practice and/or organization.

For additional information, please refer to the PDCM Payment Policy and billing guidelines for BCBSM Commercial and Medicare Plus Blue PPO Members.

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Disclaimer Statement: Although Blue Cross Blue Shield of Michigan and MICMT work collaboratively, the opinions, beliefs and viewpoints expressed by the author do not necessarily reflect the opinions, beliefs and viewpoints of BCBSM or any of its employees.

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