Final 2025 PIP program manual and supporting resources are now available

Our final 2025 PCP Incentive Program (PIP) manual and supporting resources are now available. Find information about each below and access the manuals / resources on our Provider Incentives webpage (login required).

Final 2025 PIP Manual

The following updates were made since the preliminary manual was released on Oct. 1:

  • Program measure grid (pg. 6) – The product payout and product targets have been finalized and are included in this final manual.
  • Administrative details (pg. 7) –
    - The PRA attestation information was updated to reflect the requirement to submit Group / Subgroup information for each PCP.
    - The Manual revisions information was updated to include information about a new Reports Data Dictionary, to be sent to ACNs with the first 2025 PIP reports in Mar. 2025. It will include the file requirements for our HL7 / APS data feeds to allow care gap closure.
    - The Quality Index measures were updated to include Statin Use for Patients with Diabetes (SUPD), Statin Use for Patients with CVD (SPC), Medication Adherence – Diabetes, Medication Adherence – Hypertension and Medication Adherence – Cholesterol.
    - The program deadlines were updated to be more comprehensive.
  • Access to Care measure removed – As announced in late October, the Access to Care measure has been removed from the 2025 PIP program.
  • Disparity of Care measures (pg. 16) – The product payout and targets have been finalized and are included in this final manual. Additionally, Disparity of Care will now be measured at the practice level.
  • Care Management measure (pg. 20) – Removed G0511 as a code that will no longer serve to identify members that have received care management services. Added payout PMPM and updated prepayments to quarterly. Clarified use of codes 98966, 98967 and 98968.
  • Health Information Exchange Participation with MiHIN (pg. 24) – Update to note that SDoH use case participation is required to meet the measure.
  • Appendix 1 (pg. 28) – Removed the following codes from the list of procedure codes indicating a PCP visit on which attribution is made: 99201, 99245, 99384, 99403, G0402.
  • Appendix 2 (pg. 29) – Added information about the Report Data Dictionary.
  • Appendices 4-7 (pg. 34-46) – Added updated appendices

2025 Provider Roster App (PRA) Manual

Our PRA manual has been updated for 2025 to reflect the requirement to submit group / subgroup information for each PCP. The PRA attestation cycles information has also been updated.

2025 HEDIS Provider Reference Guide

Our Healthcare Effectiveness Data and Information Set (HEDIS) Provider Reference Guide has been updated to reflect 2025 new and retired HEDIS measures. These changes were determined by the National Committee for Quality Assurance (NCQA).

HEDIS measures retiring in 2025:

  • Antidepressant Medication Management (AMM)

HEDIS measures moving from hybrid to Electronic Clinical Data Systems (ECDS) measures only:

  • Childhood Immunization Status (CIS)
  • Immunizations for Adolescents (IMA)
  • Cervical Cancer Screening (CCS)

HEDIS measures added in 2025:

  • Documented Assessment After Mammogram (DBM-E)
  • Follow-up After Abnormal Mammogram Assessment (FMA-E)
  • Blood Pressure Control for Patients with Hypertension (BPC-E)

Coming soon

Additionally, we’ll soon release the following:

  • 2025 Disease Burden Management (DBM) program manual
  • 2025 HEDIS ECDS Guide