Search

November 01, 2022

Pennsylvania Medicaid: Quality Rewards Program reimbursement increase through Dec. 31

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 DSNP and CHIP): Increase of up to 50% of contracted rate for eligible FFS providers (providers paid via capitation are excluded)

Increase details

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.

Questions?

Please contact Northeast Provider Relations at northeastprteam@uhc.com, or your Clinical Practice Consultant.

CPT® is a registered trademark of the American Medical Association.
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
PCA-1-22-3525-C&S-News_10312022
Finding news icon

Discover more news

Personalized news icon

Get personalized news