Provider Alert! Updates to the Provider Incentive Program

Provider Alert!

Provider Alert! Updates to the Provider Incentive Program

Attention: Primary Care Providers

Effective Date: August 2020

Texas Children’s Health Plan would like to thank you for the dedication and care you continually provide to our valued members. We appreciate all your effort in improving the quality of care our members receive every day. Our HEDIS metrics are just one way we see that outcome, and it is reflected in our provider incentive program (PIP) results. We would like to share an update made to our PIP because of your feedback. We value your partnership and take your comments seriously. You have provided meaningful input on this program and we have implemented enhancements accordingly

How this impacts providers: As of August 2020, we are modifying the member attribution algorithm to a provider for the purposes of calculating the HEDIS scores for the incentive programs.  

Previous algorithmMeasured PCP performance based on members who were attributed to the PCP at the end of the HEDIS measurement period 

Updated algorithmMeasure PCP performance based on the following member attribution logic 

Measure   Previous Algorithm  Updated Algorithm 
W15-well-child visits in the first month of life (6 or more visits)  PCP at the end of the calendar year  The PCP at the end of the 15 month period for each member 
IMA- Immunizations for Adolescents (Combination 2). The percentage of adolescents turning 13 who had the immunizations Meningococcal, Tdap and HPV.  PCP at the end of the calendar year  The PCP at the member’s 13th birthday 
URI- Appropriate treatment for children with Upper Respiratory Infection (URI)  PCP at the end of June of each year  The PCP at the event date  

Providers will see this change in the incentive payment that is scheduled to be made 
August 2020. 

Next steps for providers: No action required.  

If you have any questions, please email Provider Network Management at: 

For access to all provider alerts, log into: or 

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