23-762m HIP Incentive Program Offered Through December 31, 2023

Date: 08/10/23

Receive $75 Confirmation of Pregnancy Incentive

The Confirmation of Pregnancy Incentive is part of the 2023 HEDIS^®1 Improvement Program (HIP). This financial incentive recognizes and rewards HIP participating Medi-Cal primary care physicians (PCPs) for identifying pregnant members and ensuring timely access to prenatal care.

Meet HIP minimum requirements

PCPs must meet the minimum requirements of HIP to qualify for this supplemental compensation, which include:

• Currently contracting with California Health & Wellness Plan (CHWP) or a contracted IPA under the Medi-Cal program.
• Providers who have no licensing or credentialing restrictions and are in good standing with CHWP and their IPAs.
• Accurately completing, in its entirety, and returning the Confirmation of Pregnancy within the required time frames. Signatures must be included.

Use the Confirmation of Pregnancy Form

To receive the $75 incentive payment, document the pregnancy visit by completing a Confirmation of Pregnancy Form when:

• Member confirms their pregnancy in the first trimester, or
• Within 42 days of enrolling in Medi-Cal with CHWP.

Before faxing the form, ensure the following is included on it to receive the incentive:

• Member information.
• Pregnancy information.
• Rendering practitioner.

How to access the form

A fillable version of the Confirmation of Pregnancy Form (PDF) is available on the California Health & Wellness Plan website.

When are incentives processed

On a semiannual basis, $75 will be paid for each complete and accurate Confirmation of Pregnancy Form faxed to CHWP prior to the close of 2023.

Incentive separate from base compensation         

HIP is not considered part of the base provider compensation under the CHWP Provider Participation Agreement (PPA) and is separate from contracting rates with the IPA.

The Confirmation of Pregnancy is supplemental compensation offered to PCPs. Those who submit Confirmation of Pregnancy Forms for the incentive will be paid for correctly completed Confirmation of Pregnancy Forms faxed within the required time frames.

Additional information

Providers are encouraged to access CHWP’s provider portal for real-time information, including eligibility verification, claims status, prior authorization status, plan summaries, and more. If you have questions regarding the information contained in this update, contact CHWP at 877 658 0305.

¹ HEDIS–Healthcare Effectiveness Data and Information Set

This information applies to Physicians.