Pay for Performance (P4P) Program - DualChoice
Welcome to the Inland Empire Health Plan (IEHP) Pay for Performance, also known as P4P. IEHP’s P4P was designed to increase the provision of preventive health services to IEHP Members as well as improve HEDIS® results to ensure that all IEHP DualChoice Members receive timely annual assessment visits with an emphasis on review and management of chronic illnesses.
PCPs will be reimbursed directly by IEHP through the DualChoice Annual Visit program:
To learn more about P4P IEHP DualChoice Annual Visit, contact a Provider Services Representative at (909) 890-2054.
Click on the following links to jump to that specific section:Global Quality P4P Program
If you would like more information about IEHP’s GQ P4P Program or best practices to help improve quality scores and outcomes, visit our Secure Provider Portal, email the Quality Team at QualityPrograms@iehp.org or call the IEHP Provider Relations Team at (909) 890-2054.- 2021 IEHP Global Quality P4P Program Guide PCP (PDF) Update #2, Published: February 25, 2021
- 2021 IEHP Global Quality P4P Program Guide IPA (PDF) Update #2, Published: February 25, 2021
- 2020 IEHP Global Quality P4P Program Guide PCP (PDF) Published: November 9, 2020
- 2020 IEHP Global Quality P4P Program Guide IPA (PDF) Published: November 9, 2020
- 2020 Provider Quality Resource Guide (PDF) Published: September 29, 2020
Global Quality P4P Provider Meetings
Patient Experience
This toolkit is full of proven tips and successful strategies based on the kinds of questions your IEHP Members could be asked to answer regarding their Provider's service. Your Provider Relations Team has targeted nine specific topics in this toolkit to help Providers and their staff continue to achieve the highest marks in Patient experience from their IEHP Members.
Well Child
Immunizations
IEHP provides vaccine coverage based on the latest ACIP recommendation and guidelines. Please refer to the Immunization Update and "Summary of Recommendations" for both Child and Adolescents AND Adult Vaccines as follows:
- 2021 Immunization Timing Chart - English (PDF)
- Immunization Updates (PDF)
- 2021 Recommended Child and Adolescent Immunization Schedule (0-18 years) (PDF)
- 2021 Recommended Adult Immunization Schedule (19+ years) (PDF)
Adult Vaccines are a covered benefit and do not require prior authorization (must adhere to CDC/ACIP Immunization Recommendation and/or FDA approved Indication).
This toolkit contains commonly used immunization codes, best practices for reporting immunizations including information on registering with CAIR, tips on talking with parents and information on understanding vaccination hesitancy.
Reimbursement process:
Complete a CMS1500 form by including the appropriate CPT codes, quantity dispensed and billed amount.
Mail:
IEHP Claims Department
P.O. Box 4349
Rancho Cucamonga, CA 91729-4349.
For the latest updates and news regarding the vaccines, please visit CDC's ACIP website at https://www.cdc.gov/vaccines/hcp/acip-recs/index.html. By clicking on this link, you will be leaving the IEHP website.
OB/GYN P4P Program
Inland Empire Health Plan (IEHP) has released the OB/GYN P4P Program Guide which details the program requirements, performance measures, updated code sets, and payment timelines.
- OB/GYN P4P Program Guide (PDF) Published: December 28, 2020
- OB P4P Frequently Asked Questions FAQs (PDF) Published: August 29, 2019
- Postpartum Depression Screening (PDF)
Hospital P4P Program
Inland Empire Health Plan (IEHP) is pleased to announce the Hospital Pay For Performance Program (Hospital P4P) for IEHP Medi-Cal contracted Hospitals servicing Riverside and San Bernardino Counties. The goal of the Hospital P4P Program is to provide substantial financial rewards to Hospitals that meet quality performance targets and demonstrate high-quality care to IEHP Members.
- 2021 Hospital P4P Program Guide (PDF) Update #3, Published: April 01, 2021
- P4P 2021 Data Guidelines (PDF) Update #2, Published: April 16, 2021
- P4P 2021 MX Data Contribution (PDF) Published: January 12, 2021
- 2020 Hospital P4P Program Guide (PDF) Published: April 01, 2021
- P4P 2020 Data Guidelines (PDF) Published: August 13, 2020
- P4P 2020 MX Data Contribution (PDF) Published: August 13, 2020
You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.
Proposition 56
Proposition 56, the California Healthcare, Research and Prevention Tobacco Tax Act of 2016, now includes proposed supplemental payments for physicians participating in Medi-Cal Fee-For-Service (FFS) and Medi-Cal Managed Care.
- Continuation of Prop 56 and GEMT programs for FY 20/21 (PDF) Published: September 25, 2020
- Proposition 56 Extension Notice SFY 19/20 (PDF) Published: February 18, 2020
- Proposition 56 FAQs SFY 19/20 (PDF) Published: February 18, 2020
- Proposition 56 Extension Notice SFY 18/19 (PDF) Published: October 23, 2018
- Proposition 56 FAQs SFY 18/19 (PDF) Published: October 23, 2018
Click on the following links to jump to that specific section:
Electronic Payments
With the current public health situation that our country is experiencing, it is necessary for IEHP to take additional precautions to ensure the health and well-being of our community. These precautions are being reviewed, and discussed daily, by our Executive leadership team and will be implemented as deemed necessary. Future COVID-19 precautions may include reduced on-site staffing and prioritization of electronic payments over printed checks.
To minimize any disruption or delay in payment, we recommend that you sign up for electronic payments as soon as possible if you have not done so already. Our team is available to assist you with the necessary paperwork required to make this change or to answer any questions you may have. The team can be reached by e-mailing vendormaintenance@iehp.org or by calling (909) 294-3928 and selecting Option 1.
Our priority remains keeping our Members, Providers, Vendors, and Team Members safe while doing what we can to minimize the potential spread of the virus. We will continue to work hard to provide you with the level of service you have come to expect during this uncertain time.
Adverse Childhood Experiences Screening (ACES) Services
- Proposition 56 Adverse Childhood Experience Screening (ACES) Services (PDF) Published: May 15, 2020
- FAQs on Proposition 56 Payment Adverse Childhood Experience Screening (ACES) Services (PDF) Published: June 29, 2020
ACES Webinars
- ACEs Aware Initiative - Provider Engagement Webinar Series (PDF)
- ACEs Aware Initiative - Networks of Care Webinar Series (PDF)
Developmental Screening Services
- Proposition 56 Developmental Screening Services (PDF) Published: March 19, 2020
- FAQs on Proposition 56 Developmental Screening Services (PDF) Published: March 19, 2020
Family Planning Services
- Proposition 56 - Family Planning Services (PDF) Published: June 02, 2020
- FAQs on Proposition 56 - Family Planning Screening Services (PDF) Published: June 02, 2020
Ground Emergency Medical Transport (GEMT) Payment
The Department of Health Care Services (DHCS) has established a Ground Emergency Medical Transport (GEMT) Quality Assurance Fee (QAF) program. In accordance with 42 USC Section 1396u-2(b)(2)(D), Title 42 of the Code of Federal Regulations part 438.114(c), and WIC Sections 14129-14129.7, Medi-Cal Managed Care Health Plans must provide increased reimbursement rates for specified GEMT services to non-contracted GEMT providers. SPA 18-004 implements a one-year QAF program and reimbursement add-on for GEMT provided by emergency medical transportation providers effective for State Fiscal Year (SFY) 2018-19 from July 1, 2018, to June 30, 2019.
Please email completed forms to Prop56Inquiry@iehp.org or fax to (909) 296-3550.
HYDE
- Proposition 56 HYDE Services (PDF) Published: May 15, 2020
- FAQs on Proposition 56 HYDE Services (PDF) Published: May 15, 2020
Proposition 56 and GEMT Payment Schedule
- Proposition 56 and GEMT Supplemental Payment Schedule 2021 (PDF) Published: January 13, 2021
- Proposition 56 and GEMT Supplemental Payment Schedule FY 20/21 (PDF) Published: September 25, 2020
- Proposition 56 Supplemental Payment Schedule FY 19/20 (PDF) Published: June 17, 2020
Proposition 56 Payment Dispute Process
- Proposition 56 - Paid Claims Dispute Request Form (PDF)
- Proposition 56 - Encounter Dispute Request Form (PDF)
Please email completed forms to Prop56Inquiry@iehp.org or fax to (909) 296-3550.
You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.
Proposition 56 - Value Based Payments (VBP) Program
The Proposition 56 VBP Program provides directed payment to incentivize Providers for meeting specific measures aimed at delivering key quality healthcare services that improve the quality of care to Medi-Cal beneficiaries. Targeted areas are behavioral health integration, chronic disease management, prenatal/post-partum care and early childhood prevention. For more information about the VBP Program, please visit the DHCS website at https://www.dhcs.ca.gov/provgovpart/Pages/VBP_Measures_19.aspx. By clicking on this link, you will be leaving the IEHP website.
Value Based Payments Program Guide
- Value Based Payments (VBP) Program Guide (PDF) - Published: February 05, 2021
Value Based Payments Dispute Forms
- Value Based Payments Program - Paid Claims Dispute Request (PDF) Published: July 08, 2020
- Value Based Payments Program - Encounter Dispute Request (PDF) Published: July 08, 2020
Please e-mail completed forms to ValueBasedPaymentsProgram@iehp.org
At-Risk Condition Codes
The At-Risk Condition Codes list includes diagnosis codes to identify Serious Mental Illness, Substance Use Disorder or Homelessness Conditions for the VBP Program. These conditions qualify Providers for an additional payment amount for VBP services. Please refer to page 4 of the VBP Program Guide for additional details.
- At-Risk Condition Codes (PDF) Published: March 25, 2020
You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.