September 18, 2022

North Carolina Medicaid: Incentive programs

Since the launch of Medicaid Transformation on July 1, 2021, UnitedHealthcare Community Plan of North Carolina instituted 2 provider partner incentive programs:

  • UnitedHealthcare Community Plan of North Carolina Primary Care Professional Incentive (CP-PCPi)
  • UnitedHealthcare Community Plan Health Equity Program Incentive (CP-HEPi) program

CP-PCPi

The CP-PCPi program offers eligible provider partners the opportunity to earn financial incentives for helping their patients who are plan members become more engaged in their preventive health care.

Qualifying physician practices can earn rewards based on the number of patient care opportunities closed for certain Healthcare Effectiveness Data and Information Set (HEDIS®) measures, including:

  • Controlling high blood pressure
  • Cervical cancer screening
  • Chlamydia screening
  • Diabetes care
  • Childhood immunizations
  • Well child visits

CP-HEPi

The CP-HEPi rewards eligible Advanced Medical Home (AMH) providers for helping reduce health inequities associated with racial and ethnic identities.

CP-HEPi focuses on positive outcomes tied to preventive measures among underserved populations, including:

  • Controlling high blood pressure
  • Diabetes care
  • Childhood immunizations
  • Well child visits

CP-HEPi aligns with the North Carolina Medicaid Managed Care Quality Strategy to promote equity through reduction or elimination of health disparities.

Program eligibility

Participating practices must have a minimum of 100 assigned UnitedHealthcare Community Plan members (tax ID number (TIN) level) to be eligible. Notification letters will be sent to providers who meet this threshold. Advanced Medical Home (AMH) Tier 3 practices do not have a minimum assigned panel requirement.

If a CP-PCPi or CP-HEPi Payment is earned, we’ll send your practice an estimated payment no later than March 31, 2023. We’ll send a final payment less the amount of the estimated payment no later than Sept. 30, 2023.

Online resources

The following online resources will provide you with a better understanding of care opportunities

  • PATH is our quality care program that provides specifications for many of the quality measures and tools used to address care opportunities, as well as how to report data, and what billing codes to use. Learn more about PATH, its features and additional tools at UHCprovider.com/path or contact your physician advocate.
  • Patient Care Opportunity Report (PCOR) is a monthly report you can use to identify your patients’ adherence to preventive screenings, treatments and medications. Take the following steps to access your PCOR:
    • Go to UHCprovider.com and click the Sign In button in the top right corner
    • Click Documents & Reporting > Physician Performance & Reporting > Open My Reports

Questions?

Contact uhc-amh-support@uhc.com.

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
PCA-PCA-1-22-02527-C&S-News_08302022
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