Provider incentive program

Eligible providers may participate in the program

Your dedication to providing high-quality patient care is invaluable

At Carelon Health, we prioritize the delivery of high-quality patient care because we believe in its benefits. Our patient-centered care approach leads to fewer gaps in care, better health outcomes, and increased patient satisfaction. We're committed to partnering with provider groups like yours that share our commitment to exceptional patient care — and we're here to help you succeed in delivering it.

Incentive program components

Stars ratings bonuses

 

Requirement: 25-patient panel per year minimum

Clinical1 2024 bonus:

  • 5 stars: $200/patient per year
  • 4.5 stars: $80/patient per year
  • 4 stars: $50/patient per year

Pharmacy 2024 bonus:

  • 12% or more on mail order rate: $5/patient per year
  • 20% or more on mail order rate: $10/patient per year
  • 85% or more on 90-day supply prescribed: $5/patient per year
  • 15% or more on 100-day supply prescribed: $10/patient per year

Patient Annual Health Assessment Form (PAHAF) bonuses

 

Submit all PAHAFs through the provider portal .

If you do not have access to the provider portal, please contact: carelonhealth.providerrelation@carelon.com.

2024 bonuses:2

  • January–June: $300/patient per year for portal submissions
  • July–December: $200/patient per year for portal submissions
  • January–June: $200/patient per year for paper submissions
  • July–December: $100/patient per year for paper submissions

Accuracy bonus: A $10 bonus, per form, will be provided for achieving an 85% or greater accuracy (e.g., accurate and completed documentation) based on results of the coding review with a threshold of an 85% return rate.3

Patient experience bonuses

 

Requirement: 25-patient panel per year minimum by October for each measurement year

2024 rewards:

  • $20/patient 
    per year 

Questions about patient experience bonuses?
Please review our Patient experience reference guide or contact patientexperience@carelon.com.

Questions about provider incentive bonuses?
Please review our stars reference guide or contact carelonhealth.providerrelations@carelon.com.

Actively participating providers see growth in years 2 and 3

The incentive program is a three-year program. Ongoing participants can receive additional bonuses:

  • Year 2: If a provider receives the full bonus for year one, a 10% increase to the total provider bonus will be applied to year two’s calculation.
  • Year 3: If a provider receives the full bonus of year one through year two of the program, a 15% increase to the total will be applied to the year three calculation.

Jump in and get started

1 Independent monitoring measures can change year over year. Notification will take place by January 30 of current performance year.

2 All submissions must be received within 90 days from the date of submission. All 2024 PAHAF submissions must be received by January 10, 2025.

3 Accuracy bonus is only available to provider groups who return 85% of their issued PAHAFs, as well as 85% accuracy rates. Accuracy bonus paid annually by April 1, 2025.