2024 HWPE: Medicaid Fourth Quarter Bonus Campaign

HWPE Program Participants Can Earn Extra for Closing Care Gaps!

We’re excited to announce the launch of our Highmark Wholecare Practitioner Excellence (HWPE) Medicaid Fourth Quarter Bonus Campaign, which offers incentives for services rendered during the last quarter of the year to improve quality performance on select measures.

For select measures, an additional $200 payment will be made for each Medicaid member care gap closed for dates of service 10/1/2024 - 12/31/2024 and claims paid through 3/31/2025.

The eligible measures, acceptable codes (not an all-inclusive list), and measure descriptions include:

• Developmental Screening - $200 
  Developmental Screening in the First Three Years of Life.
  • Annual developmental screening by the child’s first, second, and third birthday.
  • CPT Code: 96110

• Lead Screening - $200 
  Lead Screening for Children.
  • Children 2 years of age who had at least one capillary or venous blood test for lead on or before the child’s second birthday.
  • CPT Code: 83655

• Controlling High Blood Pressure - $200
  Most recent BP is <140/90 mm Hg.
  • CPT II Code:
    • Systolic: 3074F <130 mmHg, 3075F 130-139 mmHg
    • Diastolic: 3078F <80 mmHg, 3079F 80-89 mmHg

• Glycemic Status Assessment for Patients with Diabetes (> 9%) - $200
  Most recent HbA1c level is ≤9%.
  • CPT II Codes: 3044F: Value <7, 3051F: Value ≥7 and <8, 3052F Value ≥8 and ≤9

You can access member-specific care gaps for each metric above on Highmark Wholecare’s Care Gap Management Application.

Important Note:

This bonus payment will be paid to providers who have opted in to the 2024 HWPE Program. It will be in addition to Highmark Wholecare’s current 2024 program payments for Silver or Gold quality benchmarks and percent improvement earnings. Following the end of the 2024 HWPE Program, providers will be rewarded in one lump sum payment, by June 30, 2025.

 
HWPE Program Opt-In Deadline:

As we mentioned in previous Provider News emails, the deadline to opt-in to the 2024 HWPE Program is September 30. Providers must acknowledge their intent to participate by opting-in to the core HWPE program, the Maternity Quality Program, or both.

For additional information, please contact your dedicated Clinical Transformation Consultant, visit our website, or email ProviderEngagementTeam@HighmarkWholecare.com.