2017 non-adherent member exclusion request results

Priority Health has completed our review of the non-adherent member exclusion requests submitted by practices participating in the 2017 PCP Incentive Program (PIP).

If you submitted a request, your Priority Health Provider Performance Specialist will notify you whether or not your non-adherence submissions have been approved.

  • Approved non-adherence exclusions will remove the requested member from all allowed 2017 PIP measures, not just the measure(s) for which he or she is non-adherent.
  • Denied non-adherence exclusions will include an explanation for the denial.

We will process the approved exclusions manually in the first quarter of 2018 as part of the 2017 PIP settlement.

Allowed measures

  • Cervical cancer screenings
  • Well-child visits in the first 15 months of life and 3 to 6 years
  • Chlamydia screenings
  • Colorectal cancer screening
  • Lead screening in children
  • Diabetes care, Controlled HbA1c less than 7.0%: Exclusion for refusal of lab or office visit only
  • Diabetes care, Controlled HbA1c less than 8.0%: Exclusion for refusal of lab or office visit only
  • Diabetes care, Controlled HbA1c less than 9.0%: Exclusion for refusal of lab or office visit only
  • Diabetes care, Monitoring for nephropathy: Exclusion for refusal of lab or office visit only
  • Diabetes care, Controlled blood pressure: Exclusion for refusal of office visit
  • Hypertension, Controlled blood pressure: Exclusion for refusal of office visit

Questions?

Please contact your Provider Performance Specialist