Provider Incentive Payment

Submitted by admin on Fri, 10/26/2012 - 00:00

Provider Incentive Payment

RightCare by Scott & White Health Plan has launched a provider incentive payment to promote the early identification of RightCare pregnant members.  Recognized providers may receive the following incentive payment for the completion and faxed submission of a RightCare Pregnancy Notification form or comparable telephone notification:

 

• $50 for each form submitted during the first trimester of pregnancy.
• $40 for each form submitted during the second trimester of pregnancy.
• $25 for each form submitted during the third trimester of pregnancy.

Important

Please continue to fax RightCare Pregnancy Notification forms to our Case Management Department at 512-383-8703.  Notification may also be called in by telephone to 1-855-691-7947, Option 2.

To obtain the provider incentive payment, you must submit a claim for reimbursement using procedure code 99080 and the modifier that corresponds to the member’s pregnancy trimester at the time of the initial prenatal visit:

U1 - first trimester of pregnancy

U2 - second trimester of pregnancy

U3 - third trimester of pregnancy

 

Qualifications

The following criteria must be met to be eligible to receive the provider incentive payment:

A provider may only receive one incentive payment during a member’s pregnancy.

• A provider may only receive one incentive payment during a member’s pregnancy.
• The incentive is payable only on new pregnant RightCare members initially identified by the provider office.  Any member identified prior to your submission of the form by another provider would not be eligible for the incentive program.
• The form must be submitted within five days after the member’s initial prenatal visit.
• The form must be accurately and completely filled out by the examining provider or designated staff.
• Only providers enrolled with RightCare and qualified to provide prenatal care are considered “recognized providers.”

 

The following provider types are eligible for the incentive payment:

• Family or general practitioner
• Internist
• Obstetrician or gynecologist
• Pediatrician
• Certified nurse midwife
• Advanced practice nurse practitioner
• Federally Qualified Health Center 
• Rural Health Clinic 

Thank you for partnering with us to better serve our pregnant members and optimize birth outcomes.

 

MS-A4-102
1206 West Campus Drive
Temple, Texas 76502
(855) 897-4448
TTY (800) 855-2880
www.rightcare.swhp.org

RCSWHP 9123