Primary Care Proof Forms

Incentive payments for the 2019 true up calculation will be included in the checks distributed to primary care practices in August. Primary care providers will receive a non-compliant patient list that includes those patients who were attributed to your practice in 2019 but did not meet the 2019 incentive measures based on available claims data. In the event there are patients included on the non-compliant patient list who received services in 2019, practices may submit proof forms to receive credit for these patients.

As an enhancement to the proof form process, cover sheets for each patient are no longer required. Instead, the non-compliant patient lists will include blanks in which you can write the date of service for the patients that were seen. Your patient lists will take the place of the cover sheets. Practices should submit the non-compliant patient lists with appropriate documentation (either an EOP or HCFA) via email (PFKProRelations@NationwideChildrens.org) or secure fax at (614) 355-3185. Proof forms will be accepted until close of business on November 1, 2020. Payments for all validated proof forms will be included in the November incentive check

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