Welcome to the Inland Empire Health Plan (IEHP) Pay for Performance program, also known as P4P. IEHP's P4P program was designed to increase the provision of preventative health services to IEHP Members as well as improve HEDIS® results to ensure that IEHP Members receive quality care.
Quality Performance Learning Guide
IEHP is excited to give our Providers and Provider office staff access to this convenient resource to help maximize your Pay for Performance (P4P) scores on the HEDIS measures. Each module was designed to include enduring resources as well as continually updated best practices.
Provider Quality Incentives Brochure
Inland Empire Health Plan (IEHP) is pleased to announce the 2024 Provider Quality Incentive Brochure.
- 2024 Provider Quality Incentive Brochure (PDF) | February 26, 2024
IEHP Direct Stars Incentive Program
Inland Empire Health Plan (IEHP) is pleased to announce the IEHP Direct Stars Incentive Program for Primary Care Physicians (PCPs). The goal of the program is to reward PCPs who provide high-quality care to IEHP DualChoice (HMO D-SNP) members.
- 2024 IEHP Direct Stars Incentive Program Guide (PDF) Updated: February 20, 2024
- 2023 IEHP Direct Stars Incentive Program Guide (PDF) Updated: December 19, 2023
D-SNP Model of Care Incentive Program
Inland Empire Health Plan (IEHP) is pleased to announce the D-SNP Model of Care Incentive Program for Independent Physicians Associations (IPAs). The goal of the program is to reward IPAs who provide high-quality care to IEHP DualChoice (HMO D-SNP) members.
- 2024 D-SNP Model of Care Incentive Program (PDF) Published: February 22, 2024
- 2023 D-SNP Model of Care Incentive Program (PDF) Published: February 22, 2024
Chronic Care Improvement Program Planning and Reporting Document
The Chronic Care Improvement Program (CCIP) Planning and Reporting document can be used for the following D-SNP Model of Care Incentive Program activity: Chronic Care Improvement Program (CCIP) Activity.
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.
- 2024 IEHP Global Quality P4P Program Guide PCP (PDF) Published: March 12, 2024
- 2024 IEHP Global Quality P4P Program Guide IPA (PDF) Published: March 12, 2024
- Social Need Screening and Intervention: Intervention Codes List (PDF) Published: March 12, 2024
- 2024 Global Quality P4P Coding Resource Tool (PDF) Published: February 26, 2024
- 2023 IEHP Global Quality P4P Program Guide PCP (PDF) Published: February 27, 2024
- 2023 IEHP Global Quality P4P Program Guide IPA (PDF) Published: January 17, 2024
Quality Improvement Activity Strategy Forms
The Quality Improvement Activity (QIA) Strategy Forms can be used for the following Global Quality P4P QIA Activities: Reducing Health Disparities and Potentially Avoidable Emergency Department Visits or Potentially Preventable Admissions.
Potentially Avoidable Emergency Department (ED) Visits: Potentially Preventable Diagnosis Code
The Potentially Preventable Diagnosis Code List includes diagnosis codes for visits to an ED in which the condition could be treated by a Physician or other health care Provider in a non-emergency setting or conditions that are potentially preventable or are ambulatory care sensitive.
- Potentially Preventable Diagnosis List (PDF) Published: February 12, 2024
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.
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:
- 2023 Immunization Timing Chart - English (PDF)
- 2023 Immunization Timing Chart - Spanish (PDF)
- 2023 Immunization Timing Chart - Chinese (PDF)
- 2023 Immunization Timing Chart - Vietnamese (PDF)
- 2023 Recommended Child and Adolescent Immunization Schedule (0-18 years) (PDF)
- 2023 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.
This guide contains helpful links and contact information for locations to register for CAIR2 or current users.
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:
Quality Bonus Services Dispute Form
Please e-mail completed forms to QualityPrograms@iehp.org
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.
- 2024 OB/GYN P4P Program Guide (PDF) Published: February 27, 2024
- 2023 OB/GYN P4P Program Guide (PDF) Published: January 01, 2023
- OB P4P Dispute Request Form (PDF) Published: February 08, 2024
- Postpartum Depression Screening (PDF)
Urgent Care + Wellness Quality Incentive Program
Inland Empire Health Plan (IEHP) is pleased to announce the Urgent Care + Wellness Quality Incentive Program. The goal of the program is to reward urgent care providers for providing wellness services to IEHP Medi-Cal Members.
- 2024 Urgent Care + Wellness Quality Incentive Program Guide (PDF) Published: February 23, 2024
- 2023 Urgent Care + Wellness Quality Incentive Program Guide (PDF) Published: February 27, 2024
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.
- 2024 Hospital P4P Program Guide (PDF) Published: March 04, 2024
- P4P 2024 Mx Data Contributions (PDF) Published: December 27, 2023
- IEHP P4P 2024 Data Guidelines (PDF) Published: December 27, 2023
- 2023 Hospital P4P Program Guide (PDF) Published: October 13, 2023
- P4P 2023 MX Data Contributions (PDF) Published: February 02, 2023
- IEHP P4P 2023 Data Guidelines (PDF) Published: February 02, 2023
Potentially Avoidable Emergency Department (ED) Visits: Potentially Preventable Diagnosis Code
The Potentially Preventable Diagnosis Code List includes diagnosis codes for visits to an ED in which the condition could be treated by a Physician or other health care Provider in a non-emergency setting or conditions that are potentially preventable or are ambulatory care sensitive.
- Potentially Preventable Diagnosis List (PDF) Published: February 12, 2024
Substance Use Disorders and Mental Health Diagnosis Lists
The Substance Use Disorders and Mental Health Diagnosis Lists includes diagnosis codes to identify substance use disorders, drug overdose, mental health or intentional self-harm diagnoses.
- Mental Health Diagnosis List (PDF) Published: June 23, 2023
- Substance Use Disorders Diagnosis List (PDF) Published: June 23, 2023
You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.