The Centene Care Insights Code Program

Centene has partnered with Vim to improve practices’ access to data and streamline workflows by using Vim’s Care Insights application at the point of care.

Centene’s Continuity of Care (CoC) and COC+ Data in Care Insights

Centene’s Continuity of Care (CoC) Program and CoC+ Add-On Program provides care teams with structured insights into diagnosis gaps and quality measures. This data surfaces directly in the Care Insights application, making it easier for providers and care team members to review and act at the point of care.

Note: The Centene Care Insights Code Programs described herein are applicable solely to the calendar year of 2025. In 2026, amongst other potential changes, Centene plans to combine CoC and CoC+ into a single program. Updated resources will be shared when available.

What You Can See and Do Using Care Insights

CoC Appointment Agendas (Base Program)

• An Appointment Agenda is a pre-visit checklist generated by Centene that surfaces data in Care Insights for each eligible member. It highlights diagnosis and quality gaps that require attention during the visit.
• Contents:
  
  • Known and suspected conditions needing documentation (ICD-10 / HCC codes).
  • Quality measures due for closure (some with CPT-II codes available for selection), such as preventive screenings.
  • A single agenda is generated once per member per year (providers don’t have to manage multiple agendas for the same patient).

CoC+ Add-On

CoC+ Appointment Agendas include all base program (CoC) items plus the expanded measures and SDOH/high-risk items, designed to give a more holistic picture of member health during a single encounter. Expanded Gap Types include: 

• Quality Measures
  • APV – Adult Preventive Visits
  • COA – Care of Older Adults
  • COL-E – Colorectal Cancer Screening
  • CBP – Controlling Blood Pressure
  • GSD – Glucose Screening in Diabetes
  • EED – Eye Exam for Diabetics
  • KED – Kidney Health Evaluation
  • OMW – Osteoporosis Management in Women
  • TRC – Transitions of Care
  • WHAMM – Women’s Health and Maternal Measures
    
• Drivers of Health & High-Risk Gaps:
  
  • Includes Social Determinants of Health (SDOH) factors such as housing, food security, and transportation.
  • Flags patients with multiple chronic conditions or other high-risk profiles to prioritize interventions.

Why It Matters

• Simplifies visit planning by consolidating all opportunities (diagnosis, quality, risk, and social needs) into one workflow.
• Supports accuracy in coding, quality reporting, and incentive capture in a single structured tool.

Quality Programs

• Programs vary annually under P4P (Pay-for-Performance) or P4Q (Pay-for-Quality). Contact Centene for current details.

Please note: The information on this page is provided by Vim for educational and informational purposes only. Vim is not affiliated with or responsible for administering any Centene incentive programs and does not manage, calculate, or distribute payments associated with them. All incentives and bonuses are offered directly by Centene in accordance with their program guidelines.

For details or questions about these programs, please contact Centene or your Centene representative.

Workflow Integration

• Before the Visit: Providers or staff can review the agenda to prepare for the encounter. Any insights that cannot be actioned (e.g. those already actioned/completed, those not applicable to the patient, etc.) can be dismissed with feedback sent back to Centene. 

• During the Visit: Gaps appear directly in the EHR workflow via Care Insights, prompting real-time documentation and coding in the EHR supported by actions in each insight presented within Vim.

• After the Visit: Submit a claim using your standard process, claims are not submitted through Vim.

Responding to Centene Insights through Care Insights

Providers can interact with Centene directly using Care Insights by selecting:

1. Agree - Confirms an insight is being acknowledged and addressed appropriately. If any additional documentation is needed in the EHR, it should be handled by the user.
2. Agree & Select - Confirms an insight is being acknowledged, addressed, and coded appropriately with ICD or CPT codes. If any additional documentation is needed in the EHR, it should be handled by the user.
3. Dismiss – Records a dismissal reason for feedback when an insight cannot be actioned.

Learn More

For questions about program incentives, connect with your Centene Provider Relations Representative