In mid-August, primary care practices will have access to a new set of patient lists within the Partners For Kids’ Provider Portal. The lists will show patients who were attributed to credentialed providers in 2023, and were eligible for a provider incentive plan payment (PIP) in 2023, but no Medicaid claim was filed. This scenario frequently happens when a member has both private insurance and Medicaid. For example, a provider saw a patient for a well care visit and the member’s private insurance covered it in full, in most cases, the practice would not have submitted a claim to Medicaid.  

Practices are still eligible for the PIP incentive bonuses on the patients served by either submitting an Explanation of Payment (EOP) or a Health Insurance Claim 1500 (HCFA) as proof of the service. All captured bonuses will be paid on the November PIP check. Please contact your Provider Relations Specialist for assistance or further details at PFKProRelations@ChildrensDayton.org.