Pennsylvania Medicaid: Quality Rewards Program reimbursement increase through Dec. 31
Last modified: Jan. 20, 2023
Updates: The original article incorrectly excluded UnitedHealthcare Community Plan of Pennsylvania CHIP plans from the annual wellness visit incentive. The article has been updated to correct this error.
UnitedHealthcare Community Plan of Pennsylvania increased the Quality Rewards Program reimbursement amounts effective for Oct. 1, 2022, through Dec. 31, 2022, dates of service for the following:
Quality measure benchmarks
Developmental Screening in the First 3 Years of Life (CPT® code 96110): Increase from $25 to $100 payout
Well-Child Visits (ages 3–21): Increase from $10 to $20 and from $20 to $30 payout
Controlling High Blood Pressure (CPT II codes that delineate BP results): Added measure at $50 payout per code/date of service
Comprehensive Diabetes Care – HbA1c Poor Control > 9% (CPT II codes that delineate HbA1c results): Added measure at $50 payout per code/date of service
Care opportunity closure incentives
Comprehensive Diabetes Care – HbA1c Poor Control > 9%: Pay for HbA1c report increase from $50 to $150 payout (for lab results 9% or below)
Blood Lead Level Screening for Children: Pay for lab report increase from $25 to $100 payout
Postpartum Care: Pay for medical record increase from $50 to $200 payout
Additionally, UnitedHealthcare Community Plan is offering this additional provider incentive for:
Annual wellness visits
For UnitedHealthcare Community Plan of Pennsylvania Medicaid members (excluding D-SNP): Increase of up to 50% of contracted rate for eligible FFS providers (providers paid via capitation are excluded)
Reimbursement increases will be applied to claims received prior to March 31, 2023, and will be made in accordance with state Medicaid regulations. We will not be adjusting any fee schedules or provider contracts related to this effort.
Claim adjustment process
We’ll use a combination of CPT and diagnosis codes to identify claims for adjustment.