Marketplace P4P Program quality measurement and payments
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Defines frequency of measure updates, interim payment availability, monthly reporting contents, and mid-year measurement crediting for Peach State Health Plan's Marketplace P4P Program; affects participating providers in the plan's network.
No material clinical or coverage changes in this revision.
Measurement, Reporting, and Payment Criteria
Mid-year measurement credit
Measurement and crediting when contracting mid-year
Monthly reporting
Reporting requirements
Interim and final payments
Payment reconciliation process
Measure updates
Measure update frequency and notification
Report Contents and Code References
| No codes listed |
Provider Payment Processes and Notifications
Interim payment process
Peach State supports interim payments on its Marketplace P4P quality programs; the final payout will be reconciled with any previous payments after review of charts and medical records to supplement the quality scorecard.
- Interim payments are available during the program year.
- Final payout is reconciled with prior interim payments.
- Chart reviews and medical record review will be used to supplement the quality scorecard prior to final reconciliation.
Measure change notification
Peach State will provide at least 30 days' notice before changing any measured services; measures are monitored continuously and refined on an annual basis.
- Measures are continuously monitored across the network.
- Measure focus is refined annually.
- Minimum of 30 days' notice will be given if measured services are to change.
Program Operations
OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.