Quality and HEDIS

Physician Incentives

Becoming a high performing quality care physician takes a lot of work and resources. While we strive to provide as many of the resources that can we can to help you, we also want to incentivize you for the work you are putting and for doing quality care first.

Current Incentives

2019 HEDIS Incentive Plan

The 2019 incentive plan is a pay for performance model aimed at incentivizing providers who are meeting the minimum performance thresholds. 6 Months after current HEDIS year we will compile all the data and make a payment to providers who met the performance thresholds. The incentives are tailored to your type of practice. Depending on your membership population some measures could have a lot of weightage while others may have little to no impact. Contact us to receive your incentive plan for 2019.

Measure Specific Incentives

Prenatal and Post partum Care (PPC)

Effective 4/1/2019 Nivano Physicians is implementing a notification of pregnancy and delivery incentive program! This program rewards providers on a quarterly basis for notifying us on pregnancies and deliveries so that we can ensure quality and timely prenatal and postpartum care for our members.

Pregnancy Notification:

$50 direct to provider incentive for notifying us of any pregnant Nivano Physician members before 9 weeks into their first trimester. Our goal is to identify and address risk factors of expectant mothers as early in pregnancy as possible!

Requirements:

  • Must be an active Nivano Physicians Member.

  • Notification must be sent on before the 9th week of the first trimester.

  • A Valid Claim / Encounter must be submitted to Nivano Physicians after the notification is sent.

  • Note: If PCP is submitting encounter, must include a code between O09- O99*

  • If multiple notices are received only the first encounter with notification received will be paid to that provider.


Delivery Notification:

$50 direct to provider incentive for notifying us of any Nivano Physicians member delivery within 3 weeks of the delivery date.

Requirements:

  • Must be an active Nivano Physicians Member.

  • Notification must be sent on before the 9th week of the first trimester.

  • A Valid Claim / Encounter must be submitted to Nivano Physicians after the notification is sent.

  • Note: If PCP is submitting encounter, must include a code between O09- O99*

  • If multiple notices are received only the first encounter with notification received will be paid to that provider.

*If CPSP Certified please use CPSP codes
Please fax form to (916) 720-0589. For additional information please contact:Katie Lazarus, Quality Mgt. Supervisor. Katiel@nivanophysicians.com or (916) 628- 4241

Get the PPC Notification form from the link below:

Clink to Download Form

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