The 2025 Pay for Performance Program
The Meridian Medicaid Plan (Meridian) Pay for Performance (P4P) program rewards contracted partners in care for delivering quality preventive services such as cancer screenings, immunizations, and well-child visits to members.
We listened to your opinions and added an additional, lower target (the 50th percentile) for 2025 to the Meridian P4P incentives for Primary Care Providers. We also have rewards for other providers like OB/GYNs and behavioral health providers, who offer essential services for two key measures.
Please contact your Meridian Quality Practice Advisor, Associate Quality Practice Advisor, your Provider Relations representative at ILProviderRelations@mhplan.com or, Provider Services at 866-606-3700 with questions.
The quickest way to access updated program information is via the secure provider portal. There you can view updated performance data, target percentile status, and payments earned year to date.
Primary Care Provider (PCP) Incentives*
Measure Abbreviation | Measure Name | Target 1 (50th Percentile) | Payment 1 | Target 2 (75th Percentile) | Payment 2 | Target 3 (90th Percentile) | Payment 3 |
|---|---|---|---|---|---|---|---|
AAP | Adults' Access to Care – Total | 75% | $5.00 | 80% | $10.00 | 84% | $20.00 |
BCS | Breast Cancer Screening | 53% | $10.00 | 60% | $20.00 | 64% | $40.00 |
CBP | Controlling High Blood Pressure | 65% | $10.00 | 70% | $20.00 | 73% | $40.00 |
CCS | Cervical Cancer Screening | 58% | $10.00 | 62% | $20.00 | 68% | $40.00 |
CHL | Chlamydia Screening in Women – Total | 56% | $10.00 | 65% | $20.00 | 70% | $40.00 |
CIS – Combo 10 | Childhood Immunization Status – Combination 10 | 28% | $15.00 | 35% | $30.00 | 43% | $50.00 |
CIS – Flu | Childhood Immunization Status - Influenza (2 shots) | 37% | $5.00 | 45% | $10.00 | 55% | $20.00 |
HBD | Hemoglobin A1c Control for Patients with Diabetes – HbA1c Control (<8%) | 58% | $10.00 | 61% | $20.00 | 64% | $40.00 |
IMA – Combo 2 | Immunizations for Adolescents – Combination 2 | 35% | $10.00 | 42% | $20.00 | 49% | $40.00 |
WCV | Child and Adolescent Well-Care Visits | 52% | $5.00 | 59% | $10.00 | 65% | $20.00 |
Incentives for Rendering Providers. Provider may be PCPs or OB/GYNs**
Measure Abbreviation | Measure Name | Payment | Target |
|---|---|---|---|
PPC | Prenatal and Postpartum Care – Timeliness of Prenatal Care | $50.00 | Must be completed in the first trimester |
Prenatal and Postpartum Care – Postpartum Care | $50.00 | Must be completed within 7 to 84 days after delivery |
Rendering provider may be PCP, Behavioral Health, or another qualified provider
Measure Abbreviation | Measure Name | Payment | Target |
|---|---|---|---|
FUH – 7 | Follow-up After Mental Health Hospitalization 7 day | $50.00 | No target needed |
Incentives are paid after completion of qualifying services in compliance with 2025 HEDIS® measure guidelines. A complete list of covered codes is in the HEDIS Quick Reference Guide on the Meridian website.
*Incentives are paid to the Primary Care Provider (PCP) at the provider TIN level. Payments will be made for Q1/Q2 2025, Q3 2025, and final 2025 performance throughout 2025 and 2026.
**Incentives are paid after Measurement Year 2025 is complete with an additional $50 per numerator compliant member paid to the rendering provider TIN. Payment will be made in late 2026.
Meridian maintains the right to modify or discontinue the P4P program and will notify providers of changes or program alterations.