Program Overview

Eligible primary care provider groups have an opportunity to earn incentives for closing gaps in care for Medicaid Members in need of preventive or health monitoring services. The program includes 19 quality measures. Participating Providers will earn an incentive for each claim-based member gap in care that is closed from August 1, 2022-December 31, 2022.

Access the full 2022 Medicaid Incentive Program Coding Reference Guide

• Individual Coding Reference Guides

  • Follow-Up Care for Children Prescribed ADHD Medication (ADD)
  • Metabolic Monitoring for Children and Adolescents on Antipsychotics (APM)
  • Breast Cancer Screening (BCS)
  • Cervical Cancer Screening (CCS)
  • Chlamydia Screening in Women (CHL)
  • Childhood Immunization Status (CIS)
  • Colorectal Cancer Screening (COL)
  • Eye Exam for Patients with Diabetes (EED)
  • Follow-Up After Hospitalization for Mental Illness (FUH)
  • Follow-Up After Emergency Department Visit for Mental Illness (FUM)
  • HbA1c Control for Patients with Diabetes (HBD)
  • Immunizations for Adolescents (IMA)
  • Kidney Health Evaluation for Patients with Diabetes (KED)
  • Use of Spirometry Testing in the Assessment and Diagnosis of COPD (SPR)
  • Diabetes Screening for People with Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medications (SSD)
  • Well-Child Visits in the First 30 Months of Life (W30)
  • Child and Adolescent Well-Care Visits (WCV)

  
  

Eligibility Criteria

To be eligible for this TIN level Provider Incentive Program, primary care provider groups will need to have at least 30 or more attributed MVP Medicaid Members by December 31, 2022. Additionally, eligible provider groups cannot be in a current quality pay-for-performance arrangement with MVP Health Care

If you have questions about the program or your eligibility, please call the MVP Quality Incentive Hotline at 1-866-954-1869 or email MVPQualityIncentive@mvphealthcare.com.