Primary Care Payment Model

Primary Care Payment Model PCP Tool Kit

Welcome Letter [PDF]

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

Primary Care Payment Model Program Guides can be accessed in Coreo™ under the Resource Center tab. Beginning July 31, 2023, all Primary Care Payment Model Guides and Amendments will only be available in Coreo. All previous Guides and Amendments will be removed from HHIN and will not be posted on HHIN+.

Payment

Attribution Report sample [PDF]

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

Check Cover Letter [PDF] and Payment Summary Report samples [PDF]

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 payments. Any systematic payment changes will be communicated in the cover letter.

Report to Provider samples [PDF]

Performance Measures

• 2026 Primary Care Payment Model - Provider Resource and Full Code Set
• Primary Care Payment Model - Full Code Set 2025

Measure Forms

2025

• 2025 CAHPS® Experience Process Form [PDF]
• 2025 CAHPS Experience Sample Calculation [PDF]
• 2025 Performance Gap Closure (Scored) Submission 1 Form (Due 3/31/2025) [PDF]

2024

• 2024 CAHPS Experience Process Form [PDF]
• 2024 CAHPS Experience Sample Calculation [PDF]
• 2024 Performance Gap Closures (Scored) PDSA Submission 1 Form (Due 3/31/2024) [PDF]

2023

• 2023 Performance Gap Closure (Scored) PDSA Submission 1 Form (Due 6/30/2023) [PDF]
• 2023 Performance Gap Closure (Scored) PDSA Submission 2 Form (Due 10/31/2023) [PDF]
• 2023 Performance Gap Closure (Scored) PDSA Submission 3 Form (Due 1/31/2024) [PDF]

• 2023 Supplemental Data Information (Scored) PDSA Submission 1 Form (Due 6/30/2023) [PDF]
• 2023 Supplemental Data Information (Scored) PDSA Submission 2 Form (Due 10/31/2023) [PDF]
• 2023 Supplemental Data Information (Scored) PDSA Submission 3 Form (Due 1/31/2024) [PDF]

2022

• 2022 Supplemental Data Information (Scored) PDSA Submission 1 Form (Due 6/30/2022) [PDF]
• 2022 Supplemental Data Information (Scored) PDSA Submission 2 Form (Due 10/31/2022) [PDF]
• 2022 Supplemental Data Information (Scored) PDSA Submission 3 Form (Due 1/31/2023) [PDF]

• 2022 Alternative Visits (Scored) PDSA Submission 1 Form (Due 6/30/2022) [PDF]
• 2022 Alternative Visits (Scored) PDSA Submission 2 Form (Due 10/31/2022) [PDF]
• 2022 Alternative Visits (Scored) PDSA Submission 3 Form (Due 1/31/2023) [PDF]

Closing Care Gaps with Alternative Visits

• Closing Care Gaps with Alternative Vists 2026 [PDF]
• Closing Care Gaps with Alternative Visits 2025 [PDF]
• Closing Care Gaps with Alternative Visits 2024 [PDF]
• Closing Care Gaps with Alternative Visits 2023 [PDF]

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 Press Ganey, on behalf of HMSA, to a sample of each provider’s attributed panel at the end of the measurement year.

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

• Annual Survey – Adult and Child

Total Cost of Care (TCOC)

TCOC Behavioral Health Services Exclusions [PDF]

TCOC – 14-day follow-up Incentive Code Set [PDF]

Program/Policy Change and Requests for Program Exceptions

If you disagree with an aspect of the Primary Care Payment Model 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.

Primary Care Payment Model Review Request Form [PDF] (Updated 2/2025)

*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 Primary Care Payment Model Program Guide for more details.

Resource Guide for PCP Comparison [PDF]

Revision History