Central California Alliance For Health

2019 Care-Based Incentives Resources

2019 Incentive Summary

2019 Incentive Summary

2019 Programmatic Measures Resources

Programmatic Measure Benchmarks
Performance Improvement Plan Goals

2019 CBI Tip Sheets

30-Day Readmission
Alcohol Misuse Screening and Counseling
Asthma Medication Ratio
Cervical Cancer Screening
Depression Screening and Follow-up
Diabetic Retinal Exam
Diabetic HbA1c Good Control
eConsult
Fee for Service Form Tips for Approval & Required Data Fields
Initial Health Assessment
Immunizations: Children (Combo 3)
Immunizations: Adolescents
Maternity Care: Postpartum Visit
Preventable Emergency Visits

2019 CBI Technical Specifications

Complete Technical specifications

Please click on the links below to view individual sections of the CBI Technical Specifications.


CBI Program Overview


CBI Key Terms and Definitions


CBI Program Support


Programmatic Measures Overview


Care Coordination - Access Measures


Care Coordination - Hospital & Outpatient Measures


Quality of Care Measures


Performance Target Measures


Provisionary Measures


Fee for Service Measures Overview


2019 CBI Training Resources

CBI Provider Training Workshop - Coming Soon
CBI Webinars

Beacon Health Options Resources

Behavioral Health Benefits
Primary Care Behavioral Health Referral Form
Release of Information Form (Required to receive patient updates)
Give your Health Care Providers the Full Picture (Member Handout)

General Resources

Ambulatory Sensitive Care Admissions (ACSA) Diagnosis
Emergency Care Visit Diagnosis
Health Education Programs
CAIR Immunization Registry
RIDE (Healthy Futures) Immunization Registry
Initial Health Assessment Billing Codes
Initial Health Assessment and Staying Healthy Assessment Resources
SHA Form Periodicity Schedule
U.S. Preventive Services Task Force (USPSTF) Recommendations for Primary Care Practice
Vision Services Providers for Retinal Eye Exams

Provider 2019 Care-Based Incentives (CBI) & Member Incentive Forms


PCPs must submit all Fee-for-Service CBI forms within 21 business days of the date of service.


Healthy Moms and Healthy Babies


The Alliance's Healthy Moms and Healthy Babies (HMHB) program is designed to encourage pregnant women to seek early prenatal and postpartum care. These members can earn up to $50 in gift cards.


Maternity Care: Early Prenatal Care - Providers receive payment for members who received early access to prenatal care during their first trimester of pregnancy (by the end of the 13th week) or within 42 days of enrollment with the Alliance. Pregnant moms can also receive a gift card for completing their prenatal visit.


PCPs are required to submit the Early Prenatal Care form to the Alliance within 21 business days from the date of services to indicate members have received an initial prenatal consultation in order to receive payment through the CBI program. The prenatal visit does not need to be a comprehensive official prenatal exam and can simply be a diagnosis of pregnancy and referral to relevant specialist or PCP for continued prenatal services.


   Early Prenatal Care Form


Healthy Weight for Life - PCPs may use the form below or their own form to refer members to the Healthy Weight for Life (HWL) program and report members' Body Mass Indexes (BMI) to the Alliance. This program is for members age 2-18 with a BMI at or above the 85th percentile. PCPs that complete and fax the Initial Referral, 6-Month and 12-Month follow-up Referral forms to the Alliance at (877) 793-8504 may be eligible for payment through our CBI program. Forms must be completed by the linked PCP site to receive credit. See the 2019 Fee For Service (FFS) Form Tips for approval.


Please fax only the completed referral form to the Alliance, not the prescription form. Give the completed prescription form to the patient and keep a copy in the patient's file.


   Health Weight for Life Form


Immunizations: Adolescents - Providers receive payment for adolescent members who received their required vaccines by their 13th birthday:


PCPs are required to submit a claim and update the immunization registry to receive payment. Members also qualify for a gift card for receiving the required vaccines by their 13th birthday.


Immunizations: Children - Providers receive payment for toddler members who received their required vaccines by their 2nd birthday:

  • 4 diphtheria, tetanus, acellularpertussis (DTaP);
  • 1 measles, mumps and rubella(MMR);
  • 3 Hepatitis B (HepB);
  • 4 pneumococcal conjugate (PCV)
  • 3 inactivated polio vaccine (IPV);
  • 3 Haemophilus influenzae type B(HiB);
  • 1 varicella (VZV);

PCPs are required to submit a claim and update the immunization registry to receive payment. Members also qualify for a gift card for receiving the required vaccines by their 13th birthday.






 

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