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March 2025
Office Visit
Feature Stories
We all play an important role in impacting our members’ experience. This is captured every year through the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey—and your interactions with patients has a direct impact on their response to the survey.
The CAHPS survey measures patients’ perception of their providers and their health plan. High CAHPS survey scores reflect positive relationships between our members and their providers, as well as their ability to access timely, well-coordinated care.
Here are some tips to help you provide the best care to your patients and maximize your CAHPS survey performance:
- Engage in two-way communication.
Communicate in plain language. Explain the care provided and treatment plan in a way that is easy to understand. Listen carefully. Make sure patients also understand the care they receive from other providers.
- Evaluate the need for increased appointment availability.
Consider offering same-day appointments, evening and weekend appointments, an after-hours nurse line, and virtual visits.
- Equip patients with tools.
Give members take-home material about their health conditions. Implement reminder systems and offer options to get their health records.
- Consider timeliness.
Limit telephone hold times to under 15 minutes and keep patients informed if you are running behind schedule. Try to schedule well visits/routine physicals within four weeks and non-urgent sick visits within 48 to 72 hours of their request.
Learn more about CAHPS and how to improve your scores.
EmblemHealth is adopting and incorporating recent Patient-Centered Medical Home (PCMH) payment guidance from New York State (NYS) for eligible practitioners.
As a result, we will issue payments in April 2025 at the updated rates for applicable members who have selected you as their primary care physician during the months of April 2024 up to and including September 2024. This will include retroactive payment adjustments for the providers who were already paid for services rendered during the months of April 2024, May 2024, and June 2024. We will later be issuing payments for applicable members who have selected you as their primary care physician during October 2024 and up to and including March 2025.
EmblemHealth will continue to adjust the current payment schedule for the calendar year (two separate payments will be made: one payment for members who have selected you as their primary care physician during January and up to and including June, and a second payment will be made for applicable members who have selected you as their primary care physician during July and up to and including December) to align with the state fiscal year payments received by EmblemHealth. Payment amounts will be determined by the NCQA’s Patient-Centered Medical Home Recognition Program level achieved after meeting specific elements in nine standard categories, in conjunction with the number of Medicaid, HARP, and Child Health Plus patients who have selected the eligible practitioner as their primary care physician (panel size).
More information about PCMH payments can be found in this quick reference guide.
EmblemHealth works with Veradigm to promote risk adjustment education and gap closure efforts for EmblemHealth members.
The 2025 EmblemHealth Risk Adjustment Program for Primary Care Providers (PCPs) is underway and runs from Jan. 1, 2025, through Dec. 31, 2025. The program is designed to help our PCPs identify members with chronic conditions who require an annual evaluation. The program also supports correct coding and documentation of the severity of their condition.
We look to our PCPs to maintain accurate medical records and claims coding to capture the complete health status of all NY State of Health members, Medicare Advantage HMO members, and Medicaid members.
EmblemHealth needs evidence of ongoing care to support accurate reimbursement for government programs. As a bonus, PCPs who also complete a compliant provider alert and provide the supportive progress note(s) in Veradigm’s Collaborate provider portal can receive additional reimbursement.
2025 Collaborate Provider Portal
Collaborate is a web-based tool that supports improvements in documentation, quality, and risk score accuracy. PCPs can visit Veradigm’s Collaborate provider portal via the EmblemHealth provider portal at emblemhealth.com/providerportal. See instructions for using the Veradigm Collaborate portal.
If you are interested in learning more about how you can view Veradigm’s provider resources and webinars, contact Veradigm’s Customer Support team at 800-877-5678, option 7, from 8 a.m. to 8 p.m., Monday through Friday or email support@veradigm.com.
Many providers may have already received letters from our Quality Management department as part of our annual medical record review. This is a required review for Healthcare Effectiveness Data and Information Set (HEDIS) reporting, Regulatory State reporting, and by the Centers for Medicare & Medicaid Services (CMS).
Compliance with HEDIS data collection is part of your Participating Provider Agreement(s). HEDIS and CMS consider missing records as noncompliant. Therefore, if you receive these letters — which contain a list of patients for whom we need medical records and a HEDIS Medical Record tip sheet — send us back the patient list and the section of the patient chart that shows the HEDIS measure has been met. The return fax number and secure email instructions will be noted in the letter.
NOTE: If you use outside vendors to collect medical records, it is your contractual obligation to make members’ medical records available to the plan — at no charge — for these reviews.
We appreciate your cooperation and thank you in advance for your prompt response. If you have any questions or concerns, call our HEDIS Helpline at 631-844-2420.
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