Value Based Incentive Programs
What is the Pay-for-Performance (P4P) Program?
Oklahoma’s Complete Health Pay-for-Performance (P4P) Program rewards primary care providers for improving member health outcomes. Providers can earn a bonus by scheduling appointments and addressing the target measures listed below, ensuring essential care is delivered between January 1st, 2025 and December 31st, 2025.
All claims, encounter files and/or approved NCQA supplemental electronic flat files must be submitted by January 31, 2026.
Currently, only PCP’s with assigned membership are eligible to receive a bonus for this program.
Pay-for-Performance (P4P) Instructions
Contact members, order tests and screenings, schedule appointments as applicable to help ensure that the member completes the needed tests/screenings by December 31, 2025.
Upon completion of the examination, document care and diagnosis in the patient’s medical record and submit the claims, encounter files and/or approved NCQA supplemental electronic flat files containing all relevant ICD-10, CPT and CPT II codes by January 31, 2026.
Review tests and screening results with members.
If you have any questions or need additional support, please contact us Quality_OCH@OklahomaCompleteHealth.com
Additional Conditions
Additional conditions for eligibility to receive a Bonus under the Pay-for-Performance (P4P) Program are:
Oklahoma’s Complete Health Pay-for-Performance (P4P) Program rewards primary care providers for improving member health outcomes. Providers can earn a bonus by scheduling appointments and addressing the target measures listed below, ensuring essential care is deli
1. All Pay-for-Performance Providers must: (a) be in a participation Agreement with Oklahoma Complete Health (OCH), either directly or indirectly through a Vendor, from the Effective Date and continually through the dates the Bonus payments are made, and (b) be in compliance with their participation Agreement including the timely completion of required training or education as requested or required by the Plan.
2. Bonuses are paid to the Eligible Member’s Provider of record at the end of the applicable measurement periods as defined by the Pay-for-Performance Program.
3. Any Bonus payments earned through this Pay-for-Performance Program will be in addition to the compensation arrangement set forth in your participation Agreement, as well as any other OCH incentive program in which you may participate. At OCH’s discretion, Pay-for-Performance Providers who have a contractual or other quality incentive arrangement with OCH either directly or through an IPA/Vendor may be excluded from participation in this Pay-for-Performance Program.
4. The terms and conditions of the participation Agreement, except for appeal and dispute rights and processes, are incorporated into this Program, including without limitation, all audit rights of OCH, and the Pay-for-Performance Provider agrees that OCH or any state or federal agency may audit his/her/its records and information.
5. The Program is discretionary and subject to modification due to changes in government healthcare program requirements, or otherwise. OCH willdetermine if the requirements are satisfied and payments will be made solely at OCH’s discretion. There is no right to appeal any decision made in connection with the Program. If the Program is revised, Plan will send a notice to Pay-for-Performance Provider by email or other means of notice permitted under the participation Agreement.
6. OCH reserves the right to withhold the payment of any Bonus that may have otherwise been paid to a Pay-for-Performance Provider to the extent that such Pay-for-Performance Provider has received or retained an overpayment (any money to which the Pay-for-Performance Provider is not entitled, including, but not limited to, Fraud, Waste or Abuse) from the Plan, or Plan’s Eligible Member. In the event OCH determines a Pay-for-Performance Provider has been overpaid, OCH may offset any Bonus Payment that may have otherwise been paid to the Pay-for-Performance Provider against overpayment.
7. Only one Bonus Payment will be made for a specific HEDIS® member-measure combination.
8. Plan shall make no specific payment, directly or indirectly under a provider incentive program, to a Pay-for-Performance Provider as an inducement to reduce or limit medically necessary services to an enrollee, and this Pay-for-Performance Program does not contain provisions that provide incentives, monetary or otherwise, for withholding medically necessary care. All services should be rendered in accordance with professional medical standards.