Provider Profile Users Guide

1. Payment Cycle
   This six-month period represents when the incentive is paid.
2. Claims Data
   This twelve-month period represents the claim dates of service used to determine your practice ranking in the program.  Please keep in mind that certain HEDIS measures require review of more than one year of claims data.
3. Practice Information
   This box provides basic information about your practice. It includes your practice name, provider number and specialty type.  It also includes your average panel size during the twelve-month period being evaluated and the average panel size of your peer practices during the same period of time.
4. Quality Performance
   This box contains the practice quality performance related to the eight HEDIS measures.  It contains your practice score for each measure.  It also contains your overall practice score for all eight HEDIS measures rolled-up and your percentile ranking when compared to your peer practices.  If the percentile ranking is eligible for an incentive payment, and information is also included.  A more detailed breakout of these services is available from your Provider Account Executive upon request.
5. Access Other Metrics
   This box contains your practice panel status.  It also contains your practice percentile ranking for the following program components: Severity of Illness; Medical Cost Management, Total ER Utilization and Non-Emergent ER Utilization.  If the percentile ranking is eligible for an incentive payment, that information is also included.  As a point of reference, the practice percentile ranking for Severity of Illness (based on all claims for panel members) is included. This is for informational purposes only and is not an eligible incentive component. A more detailed breakout of these services is available from your Provider Account Executive upon request.
6. Actual/Potential Bonus
   This box contains the total bonus earned by your practice (on a Per Member Per Month basis) and your practice’s total potential bonus.
7. Inpatient Utilization
   For informational purposes, this box contains the top 5 hospitals used by your practice for inpatient care. Also included are the number of admissions per hospital and the percentage of inpatient dollars per hospital. A more detailed breakout of these services is available from your Provider Account Executive upon request.
8. Specialty Utilization
   For informational purposes, this box contains the top 5 specialties used by your practice. Also included are the number of specialty care visits per specialty type and the percentage of dollars per specialty type. A more detailed breakout of these services is available from your Provider Account Executive upon request.
9. Demographics
   For informational purposes, this box contains panel demographics as of the end of the twelve-month period used to rank the practice (see #1 Profile Period).
10. Run Date
    The date when you QCCP profile was generated.