In 2008, MHCP implemented a P4P program for MHCP fee-for-service (FFS) providers. The program awards $250 up to two times every 12 months when physicians or advance practice registered nurses (APRNs) render optimal chronic disease care to their qualifying MHCP recipients with cardiovascular disease or diabetes or both. MHCP will use a combination of four clinical results for cardiovascular disease and five treatment measures for diabetes to determine if the provider is eligible for a results payment.
Clinical results for optimal care are:
Each successful P4P request is paid individually. It will appear on the Remittance Advice and include the recipient and payment information.
P4P rewards requests will be denied if the NPI/UMPI does not exactly match the location where the provider rendered the associated clinical evaluation and management procedures and laboratory services. Providers must select the correct clinic location when submitting claims with a consolidated NPI/UMPI or MHCP will deny the claim.
Providers must resubmit the reward request with the correct NPI/UMPI to receive the reward payment if the initial request is denied. Refer to the Billing section for directions on submitting a request.
If a documented contraindication for aspirin exists, the recipient may not be disqualified. In those instances, MHCP has a limited P4P exception process to evaluate claims that would not normally meet the target for a results payment.
The following enrolled provider types are eligible to receive payment for this service:
MHCP FFS recipients of Medical Assistance (MA) and MinnesotaCare are eligible for this service if they meet the following criteria:
Recipients not eligible for the cardiovascular disease or diabetes P4P program are those:
Indian Health Services (IHS) providers may not collect a P4P results payment for recipients enrolled in the MHCP Programs MA, EH, RM, and Minnesota Care FF and LL.
Providers must document the required clinical results in the patient medical record. Results must be associated with the six-month period immediately preceding the submitted transaction in MN–ITS Interactive.
To receive the P4P results payment, the claiming provider must have:
Providers rendering optimal care to recipients with both qualifying diagnostic categories in a 180-day period may receive two results payments per qualifying recipient.
For questions about denial reasons or the NPI/UMPI, contact the Provider Call Center at 651-431-2700 or 1-800-336-5411.
Claims to support P4P must include appropriate revenue and HCPCS/CPT codes.
For FQHCs/RHCs to be eligible to earn P4P results payments, a physician or an APRN must provide the services.
Recipients with a medical contraindication for aspirin (allergy or taking a medication that should not be used with aspirin) must submit documentation for approval before a results payment can be awarded. If you indicated the recipient qualifies for this exception, after submitting the P4P results print the response page, attach the required documentation, and mail or fax (secure fax is preferred) to MHCP for review at:
P O Box 64986
St Paul, MN 55164-0986
Fax: (651) 431-7577
Optimal Diabetes Care: Compliant with all five of the clinical results for optimal care listed.
Optimal Cardiovascular Care: Compliant with four of the clinical results for optimal care listed.
MS 256.01, subd. 2b Performance paymentsReport/Rate this page