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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 within the Vim Connect 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 the Medicare Advantage Pay-for-Quality (P4Q) program. 

Medicare Advantage Pay-for-Quality (P4Q) Program

The Medicare Advantage Pay-for-Quality(P4Q) Program awards providers for improving clinical quality for members enrolled in Medicare Advantage plans by focusing on key quality 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. 

Pay-per-Gap Closure
Providers can earn a per-gap payment for closing specific quality measures


Quality - Managing Chronic Conditions

Measure Dollar Amount Frequency
Controlling Blood Pressure $25 Annual
Glycemic Status Assessment $25 Annual
Diabetic Eye Exam $25 Quarterly
Kidney Health Evaluation for Patients with Diabetes $25 Quarterly

Quality - Screenings

Measure Dollar Amount Frequency
Breast Cancer Screening $40 Quarterly
Colorectal Cancer Screening $40 Quarterly

Quality - Event Based

Measure Dollar Amount Frequency
Osteoporosis Management in Women $500 Quarterly

Pharmacy

Measure Dollar Amount Frequency
Statin Use in Persons with Diabetes $25 Annual
Concurrent Use of Opioids and Benzodiazepines $25 Annual

Med Adherence *3
(MAC, MAD, MAH)

 $25 each Annual

 

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.