Learn about upcoming PIP deadlines and changes to our 2021 PIP manual
We want to remind you of upcoming PCP Incentive Program (PIP) deadlines and share updates to our 2021 PIP manual.
Important PIP deadlines
Provider Roster Application (PRA)
Our first PRA attestation period is ending on May 17, 2021. This means Accountable Care Organizations (ACNs) need to have their provider roster updates entered and attested to by May 17, 2021, at 5 p.m.
Visit our PRA page to learn more about this new tool.
Second quarterly Behavioral Health Collaborative Care meeting
- Tuesday, May 25, 2021, from 12 to 1 p.m.
- Register for the meeting
Social Determinants of Health (SDoH) attestation survey
- Submit to PH-PartnersinPerformance@priorityhealth.com by Friday, May 28, 2021
- Complete the attestation survey on behalf of one or multiple practice sites
- Review additional information on our SDoH page
2021 PIP manual updates
Program measure grid (pg. 5)
- The 2020 health plan 75th percentile performance for the Well Child Visits: 3-11 Years has been calculated and added to the measure grid. The target for the HMO/POS and ASO/PPO populations is 79%. The target for the Medicaid population is 62%.
- The Acute Hospital Utilization and Emergency Department Utilization measures were added to the grid. These are report only measures.
Administrative details (pg. 11)
- Post settlement review submissions must be submitted for review within 15 days of settlement payment.
Program deadlines (pg. 12)
- The deadline for post settlement reviews has changed to June 15, 2022, to allow time for processing prior to Global Risk Score (GRS) settlement.
Well Child Visits 3 – 11 Years (pg. 25)
- Included targets for HMO/POS, ASO/PPO and Medicaid populations. HEDIS revised this measure to include children between the ages of 3-11 years old instead of 3-6 years old. The 2020 health plan 75th percentile performance for the Well Child Visits: 3-11 Years has been calculated and added to the measure specifications. The target for the HMO/POS and ASO/PPO populations is 79%. The target for the Medicaid population is 62%.
Care management – Standard PIP practices and Care management – CPC+ practices (pg. 61-71)
- Added the language “prior to June 30, 2020” to the MiCMRC Complex Care Management Training course. The MiCMRC Complex Care Management Course is no longer offered. However, care managers who took part in this training prior to June 30, 2020, are considered compliant with component 3 of this measure for initial training.
- Changed the requirement for care managers to be trained prior to providing and billing for care management to allowing for a six-month grace period for care managers to be trained.
Care management – CPC+ practices (pg. 69-70)
- Clarified standard and stretch PMPMs with added grid
Social Determinates of Health (SDoH) (pg. 72-73)
- Corrected the URL for the Centers for Medicare & Medicaid Services Accountable Health Communities’ 10-question screening tool. The new URL is:
- Added clarification to the notes stating, “An approved z-code billed on any professional or institutional claim will count toward the numerator”.
- Added information about Priority Health Connect to the notes section on page 73. Priority Health Connect is an online platform designed to connect individuals in the community with free and reduced-cost programs and critical social services. All Priority Health members can now connect themselves to resources at no cost by using Priority Health Connect.
Behavioral Health Collaborative Care (BHCC) (pg. 81)
- Added language to confirm that courses provided by Mi-CCSI and MCCIST, as part of the BCBSM CoCM program, may also be credited as training for the Priority Health BHCC program.