HEDIS & PIP reporting updates for the 2024 and 2025 performance years
We’re sharing several updates related to HEDIS and PCP Incentive Program (PIP) reporting:
2024 performance year information
December Filemart reports include historical data
Your December 2024 PIP reports include historical data, including care gap closure and member exclusions for the following multi-year measures:
- Breast cancer screening (BCS-E)
- Cervical cancer screening (CCS)
- Colorectal cancer screening (COL-E)
Please reference your reports for gap closure status and ensure all supplemental data for 2024 dates of service is submitted to us by Jan. 31, 2025, by 5 p.m. Eastern Time.
If when reviewing your December reports, you notice care gaps you believe should be closed but aren’t, please let your Provider Strategy & Solutions consultant know so we can review your data feeds and determine a course of action.
For care gaps that aren’t closing through our standard digital submission methods, you may also submit medical record documentation directly to our HEDIS team via:
- Secure SharePoint site: ACNs may request access to our HEDIS SharePoint, to be able to securely upload files for our team’s review
- Email: ACNs can email files to HEDIS@priorityhealth.com – page 11 of our 2024 PIP Manual (login required) includes tips on submitting via email
- Fax: 616.975.8897
- Mail: 1231 E. Beltline NE Mail stop 1280, Grand Rapids, MI 49525
2025 performance year information
One-time immunization & lead screening reports
To support care gap closure for the 2025 PIP program year, in January 2025, we’ll send you a one-time report showing your members with open care gaps for the following measures that will no longer be eligible in the measures on their birthdate between Jan. 1 – Apr. 1, 2025:
- Childhood Immunizations: Combo 3 (CIS)
- Immunizations for Adolescents (IMA)
- Lead Screening (LSC)
We’re releasing this one-time report ahead of our regular 2025 PIP report run to ensure you have the time-sensitive data before the members expire in the measures.
This one-time report will be based on 2024 eligibility. Data updated with 2025 eligibility will be available with our first 2025 PIP reports.
First 2025 PIP reports to be released in March
The first batch of monthly 2025 PIP reports will be delivered to you via Filemart on or around Mar. 20, 2025.
REQUIREMENTS AND RESPONSIBILITIES
Reminder: You must complete our 15-minute, CMS-required D-SNP Model of Care training by Dec. 31
Providers play an integral role in the care teams that support our dual-eligible special needs (D-SNP) members. That's why the Centers for Medicare and Medicaid Services (CMS) requires us to make sure providers who are contracted with us to see PriorityMedicare patients are trained on our Model of Care.
Our Model of Care is a quality improvement tool that ensures the unique needs of our D-SNP members are met and describes the processes and systems we use to coordinate their care.
Who needs to complete Model of Care training?
- All providers who are part of the Priority Health Medicare Advantage network. (All providers aligned with this network must complete the MOC training, regardless of whether they participate in Medicaid.)
- Out-of-network providers who see at least five D-SNP members
This includes specialists, ancillary providers and anyone part of an ICT (interdisciplinary care team) for a D-SNP member. This is a CMS requirement.
Your Provider Strategy & Solutions Consultant will reach out to you with a report of providers who need to complete training and/or a report of providers who entered an incorrect NPI and need to re-attest to training.
How to access training
You can choose to group our training with any existing, required training (like compliance training) or use our 15-minute on-demand webinar.
Important note: Provider registration for the on-demand webinar counts as attestation, which means no additional documentation is required. However, if you choose to group your training with other required training, you must submit a bulk attestation. To do this, fill out the roster template with providers who’ve received training. If you submit a provider roster, only the Priority Health MOC roster Excel sheet provided will be accepted. (Please do not submit any other forms of attachments.) Send attestation rosters to DSNPtraining@priorityhealth.com.
Refer to our Provider Manual for details on how to complete training.
Training needs to be completed and attested to by Dec. 31, 2024. Late submissions will not be accepted.
TRAINING OPPORTUNITIES
Register now for our 2025 provider webinars
Our webinars are a great way to connect with you and your practice as we share important updates and reminders. We hope you'll join us in 2025 at the webinars that are relevant to you.
What are the provider webinar dates for 2025?
Topic
Date
Billing & coding (including content on prism, credentialing/enrollment, authorizations and general tips)
Medicare & Medicaid quality (including content on behavioral health, our PCP Incentive Program, Disease Burden Management and HEDIS measures)
Product (both reminders and updates)
Pharmacy (including formulary changes and related product change reminders)
Incentive programs (PIP, DBM)
Click the links above to register for each webinar. No need to wait: registration is already open.
Specific subtopics will be announced a month prior to each webinar.
Are there any changes to the provider webinar format for 2025?
To continue reaching audiences with targeted content, we’re ending the previous bi-monthly “bundled” format and moving to a monthly cadence. All content in each webinar will be closely related.
Where can I find registration links and recordings of past webinars all in one convenient place?
All this can be found on the provider webinars page in our provider manual.