Primary Care Provider Incentive Payments (PCPIP) Update

October 12, 2012

MaineCare has completed the PCPIP for eligible providers for the reporting period of 10/1/2010-9/30/2011. Payments will be processed during the payment cycle week ending October 19th. Electronic Fund Transfer (EFT) payments will be received during the week ending October 19th. Paper checks will be mailed during the week ending October 26th. Prior to payment, providers will receive a mailing that includes:

  • A Utilization Review report
  • PCPIP calculation details
  • Contact information for payment questions

There may be some changes in payment amounts from prior PCPIP payments. These changes are for one of the following reasons:

  1. Office-based Primary Care Provider practices that are not an FQHC, RHC or affiliated with a hospital qualify for the PCPIP. Some practice sites, also known as service locations, made changes that rendered them ineligible. Therefore, there were fewer service locations qualified to participate in the PCPIP program.

  2. With MIHMS implementation, many members were assigned to a rendering provider as their Primary Care Provider (PCP), rather than a service location. In order to assign these members to a service location, PCPs were attributed to the service location where most of their MaineCare services were performed during the reporting period. For payment purposes, all members assigned to these PCPs were then attributed to that service location, as well.

For any questions regarding PCPIP, please contact PCP Network Services at 1-866-796-2463 extension 73320 or extension 76349.