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Payment Transformation

 

Payment Transformation PCP Tool Kit

Welcome Letter

 

Informational Session for Primary Care Providers 12/01/15 (Video)

 

Payment Transformation Made Simple (a brochure for providers)

 

Payment Transformation Program (a brochure for patients)

 

Order Form for Patient Brochures

 

To order more brochures for your office, complete and return this order form.

 

Payment Transformation Program Guide is available on HHIN. Click here to log in.

 

2019 Full Code Set 

 

2019 Coding Guidelines (updated 01/2019)

 

Code set archive:  To access full code sets from previous years (2016-2018), please click here.

 

Coreo Resource Library

 

For help, you may also call 892-3428 on Oahu or 1 (888) 600-4672 toll-free on the Neighbor Islands.

 

Additional Training Resources

 

 

Payment

Understanding Your PMPM Band

 

A step-by-step reference guide to understanding your PMPM band calculations. Use this in combination with your individual PMPM band worksheet.

 

Patient Attribution (updated 11/30/2017)

 

A quick overview of patient attribution and how to add patients to your panel for each line of business.

 

Attribution Report sample

 

Attribution reports are produced monthly and are available in an electronic format.

 

Check Cover Letter and Payment Summary Report samples

 

A sample of the cover letter and Payment Summary Report that accompanies your monthly PMPM check. Letters, reports, and checks are sent to the entity the provider designated for all PT payments. Any systematic payment changes will be communicated in the cover letter.

 

Report to Provider samples

 

 

Performance Measures

Payment Transformation Performance Measure Reporting Guidelines (updated 03/07/2019)

 

A compilation of acceptable codes for select Performance Measures, and claims filing guidance specific to certain HMSA plans. For measure descriptions and specifications, please refer to the Payment Transformation Program Guide. Complete code sets for the Performance Measures are also available on HMSA’s Provider Resource Center, under Payment Transformation.

 

 

Screening Tools for Payment Transformation Performance Measures

 

A list of screening tools for the Payment Transformation Performance Measures, and where to access them.

 

 

Influenza Vaccine Improvement Plan Forms (Posted 03/20/2019)

 

The 2019 Influenza Vaccine improvement plan forms are designed to help POs assess their performance and collaborate on improvement strategies. All forms must be complete and on time to receive compliance for this measure.  

 

 

Engagement Measures

Patient Satisfaction Survey samples

 

These sample surveys are provided for your information; please do NOT distribute to patients. The surveys are administered by SPH Analytics, on behalf of HMSA, to a sample of each provider’s attributed panel every quarter, as well as at the end of the measurement year.

 

Annual survey responses are used to score the PCP Engagement Measure, Quarterly survey responses are used to score the PO Engagement Measure.

 

PO Engagement Measure -- Physician Experience: Source and Definition of Burnout

Recording of a presentation, “Exploring Physician Experience and Identifying Sources of Stress” to Physician Organizations on February 28, 2019 by Colin P. West, MD, PhD, FACP, Professor of Medicine, Medical Education, and Biostatistics, Divisions of General Internal Medicine and Biomedical Statistics and Informatics, Departments of Internal Medicine and Health Sciences Research, Mayo Clinic (90 minutes long)

 

 

Total Cost of Care (TCOC)

Total Cost of Care (updated 01/04/2017)

 

An overview of the Total Cost of Care shared saving bonus incentive. Detailed methodology is available in the Payment Transformation Program Guide, Appendix G.

 

TCOC Behavioral Health Services Exclusions

 

 

Requests for Reconsideration and Program Exceptions

If you disagree with an aspect of the Payment Transformation program and wish to request a review, please use the following form.  Please fill out the form in its entirety and include any supporting documentation.  Email the form and supporting documentation to PSinquiries@hmsa.com.

 

Payment Transformation Review Request Form (Effective 10/1/2018)

 

*NOTE: Do not use this form if you are requesting to exclude a member from the denominator of a performance measure.  Those requests should be submitted electronically through Coreo. Please see the Payment Transformation Program Guide for more details.

 

 

PT: 05/2019

 

 

To access the previous version of this page, please refer to Payment Transformation - OBSOLETE.

 

 

First Published:01/17/2019
Latest Revision:05/01/2019
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