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Primary Care and VFC Incentive Program
Effective for services provided January 1, 2013, through December 31, 2014, MHCP reimburses the following services at enhanced rates to eligible providers under the Primary Care and Vaccines for Children (VFC) Incentive Program:
Eligible services may be provided to fee-for-service (FFS) MHCP recipients or enrollees covered by DHS-contracted managed care organizations (MCO).
See Enhanced Rates for information about implementation of the enhanced rates and claims reprocessing.
To be eligible for enhanced payment of the covered services, physicians must currently practice in one of the following specialties, as defined by the American Board of Medical Specialties (ABMS), American Board of Physician Specialties (ABPS) or American Osteopathic Association (AOA):
In addition to practicing in one of the above specialties, an eligible physician must meet one of the following:
The 60% claims history criteria applies to the physicians entire scope of practice. The calculation must include all Medicaid services paid to the physician at all locations or practices where he or she provides services.
Eligible physicians must complete and sign the Physician Primary Care and VFC Incentive Program Applicant Assurance Statement (DHS-5211) and fax to the number listed on the form. Submit only one form per eligible physician.
Board certified eligible physicians who practice outside the state of Minnesota must submit a copy of their certificate with the form.
Covered services provided by individually enrolled physician assistants (PAs) and advanced practice registered nurses (APRNs) are eligible for enhanced payment when supervised at all times by a physician who:
Both the PA or APRN and the supervising eligible physican must complete and sign the Non-Physician Primary Care and VFC Incentive Program Applicant Assurance Statement (DHS-2649) and fax to the number listed on the form.
The earliest date of service for which a provider is eligible to receive enhanced rates is determined by the date they submit their assurance statement to MHCP.
MHCP will perform reviews on a statistically valid sample of providers to verify the eligibility criteria. Services retroactively found ineligible for the enhanced payment will be subject to recoupment of the overpaid amount.
Use the Ordering/Prescribing Providers list to identify providers who have submitted an assurance statement and are eligible for the enhanced rates. To access the list:
Eligibility for the enhanced rates is indicated in the Enhanced Service column with the following codes:
The providers eligibility begin date for enhanced rates is indicated in the Begin Date column, to the right of the applicable enhanced service code.
Providers are not eligible for enhanced rates when delivering services under one of the following:
Enhanced rates are in effect for claims submitted to MHCP fee-for-service on and after August 13, 2013.
MHCP has not received federal approval for Managed Care Organizations (MCOs) to implement enhanced rates at this time. MHCP will notify providers when MCOs are able to implement the enhanced rates.
Refer to the MHCP Fee Schedule to view enhanced rates for the covered services. Factor code V indicates the enhanced rate for the procedure code listed.
The following standard adjustments may affect final payment amounts:
For all eligible providers, MHCP reprocessed claims with dates of service back to the providers eligibility begin date. Reprocessed claims will appear on the remittance advice for payment date October 22, 2013 and will be paid at the applicable enhanced rate.
Service For purposes of calculating the claims history criteria, the term service refers to a single service or session. Examples of how to count different services include:
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