How are PMPs reimbursed?
In addition to the administrative fee, PMPs are reimbursed based on the fee-for-service schedule. Claims are submitted to the state’s fiscal agent, HP, for processing and payment. HP pays the prevailing Medicaid reimbursement rate on file for each service appropriately billed to the IHCP. The CMOs also offer a variety of provider incentives related to quality improvement goals, which could be in the form of a bonus above the provider’s fee-for-service rates. The State also reimburses PMPs $20 for care coordination conference services. The coordination conference can be billed using 99211 SC and is limited to twice per calendar year, per Care Select member.
