Value-Based Care Program Updates

March 7, 2019
Value-Based Care Program Updates

Thank you to our CPC+ and PCMH program participating providers for helping us improve healthcare! Please review these updates to the programs.

Care Plan Dates

We strongly encourage practices to develop care plans for high-risk members. However, as of January 1, 2019, the dates are no longer required to be entered in your My Account provider portal at

PMPM Payments

Effective January 1, 2019, quarterly per member per month CPC+ or PCMH payments will be transmitted on a separate provider remittance advice from your normal claim payments. You will continue to receive your PMPM payments in the same manner as you have in the past (EFT, bank card, etc.). This should make it easier to track and account for CPC+ or PCMH payments. 

Quality Ratings Reminder

Category II CPT codes may be submitted for reporting of quality data. Category II codes must be submitted as eCQMs for these measures:

  • Controlling Blood Pressure
  • HbA1c Poor Control
  • Tobacco Use

To help improve your quality measure ratings, submit the Supplemental Data Submission Form, available on the My Account portal.

Transitional Care Management Services

Effective January 1, 2019, QualChoice now covers transitional care management services. These services may be required for patients who are discharged from a facility stay, to help with the transition back to their usual living situation and decrease the likelihood of readmission. Review details in Provider Manual.

For Questions or More Information

For questions, email or

Learn more about QualChoice value-based care programs.