Pay for Performance Program

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. 


Provider Quality Incentives Brochure

Inland Empire Health Plan (IEHP) is pleased to announce the 2024 Provider Quality Incentive Brochure.


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.


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.


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.


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.


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:

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


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.


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.


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.


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.


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.


You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.