The Elevance Health Care Insights Code Program

Elevance Health has partnered with Vim to improve practices’ access to data and streamline workflows by using Vim’s Care Insights application on the Vim platform.

With Care Insights, providers can view key quality measures, identify care gaps, and take action directly within their EHR—no separate portals or paper reports required. This integration links the codes surfaced in Care Insights to national quality programs (Medicare Stars) to support coding accuracy and performance tracking.

2025 Medicare Stars Provider Quality Incentive Program

The 2025 Medicare Stars Provider Quality Incentive Program rewards providers for improving clinical quality for members enrolled in Medicare Advantage plans by focusing on key Stars measures. It is designed to improve healthcare outcomes for members by expanding access to preventive care services and incentivizing providers to address targeted clinical quality results. 

Program Components

• Pay-per-Gap Closure - Providers can earn a per-gap payment for closing specific quality measures for members on the Member Target List provided by Elevance Health. 
  • Incentives range from $25–$200 per gap, depending on the measure (e.g., blood pressure control, diabetes management, cancer screenings, osteoporosis care, and medication adherence).
  • Payments are based on claims, encounter data, and medical records during the measurement period.
• Clinical Composite Score - Providers are eligible to receive an incentive payment based on a weighted composite score across specified quality and pharmacy measures, with performance calculated at the practice level.
  • Scores determine per-member, per-year (PMPY) payment: $50 for 3.75–3.9999, $75 for 4.0–4.2499, $125 for 4.25–4.4999, and $200 for >4.5. Attribution is captured as of December 31, 2025, and payments are issued in Q2 2026.
• At-Risk Member Bonus Opportunity - Providers are eligible to earn additional bonuses for improving gap closure for members identified as high-risk due to unaddressed care gaps or social risk factors.
  • Payments range from $25–$40 per measure, depending on the measure, and are in addition to standard pay-per-gap closure incentives. Semi-annual bonuses (Jan–Jun 2025) are paid in Q3 2025, and annual bonuses are paid in Q2 2026.

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

Workflow Integration

• Before the Visit: Open Care Insights to review gaps and prepare for the encounter. Any insights that cannot be actioned can be dismissed with feedback sent back to Elevance Health.
• During the Visit: Address gaps in real time, document findings, and capture ICD-10 and CPT-II codes directly in the encounter.
• After the Visit: Submit a claim using your standard process — claims are not submitted through Vim. Care Insights updates Elevance Health on actions taken within the application.

Responding to Elevance Health Insights through Vim

Care teams can interact with Elevance Health 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.

Questions & Support

For questions about Elevance Health program incentives, contact your Elevance Health Provider Quality or Network representative.