Updates to 2020 PIP and CPC+ program manuals

We’ve updated the 2020 PCP Incentive Program (PIP) and Comprehensive Primary Care Plus (CPC+) Incentive program manuals.

2020 PIP and CPC+ program manual updates include:

  • Addition of survey attestation hyperlinks
  • Addition of the Acute Hospital Utilization (AHU) and Emergency Department Utilization (EDU) technical specifications
  • Updates to some of the program measures

Program manual update details

Glossary (pg.10)
Added definition: Participating PCP - A primary care provider that is credentialed by and contracted with Priority Health to provide Covered Services to a member.

Program deadlines grid (pg. 13)
Medication Therapy Management and Risk Adjustment survey hyperlink added

Colorectal cancer screening (pg. 29 PIP manual; pg. 31 CPC+ manual)
Method of measure added: Measure is scored based on evidence of the procedure via supplemental data or claims, not the result.

Depression screening and follow-up (pg. 32)
Notes section added: PHQ 2, PHQ4, PHQ9 result is required. If screened positive, appropriate follow-up care is required.

Medication adherence for cholesterol (pg. 50)
Denominator update: 18 years and older with at least two fills of statin cholesterol medication(s) on unique dates of service during the measurement period.

Reporting – PIP_011M – Medication Adherence

Risk Adjustment (pg. 70-71)
Notes section added: Practices participating in Advanced Health Assessment (AHA) at any time in 2020 are not eligible for the risk adjustment measure. Product specific eligibility applies.

Example: ABC practice is participating in AHA for Medicare only. The Medicare product is excluded for ABC practice for the Medicare Risk Adjustment incentive measure, however, the Medicaid product is included for ABC practice for Medicaid Risk Adjustment incentive measure.

Priority Health may request documentation supporting your risk adjustment education policies/process for attested practices at any time during the program year, for all lines of business. Failure to provide this if requested, will result in ineligibility for the risk adjustment incentive measure.

Acute Hospital Utilization (pg. 74-75)
Technical specification added

Emergency Department Utilization (pg. 76-77)
Technical specification added

Codes set (pg. 100)
CPT II 3045F removed; CPT-II 3051F and CPT-II 3025F are the replacement codes

2020 Quick reference guide (pg. 133)
Added new quick reference guide by incentive measure