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Healthier Outcomes incentive program

Just as every member has unique needs, the providers who care for them do, too. So we offer you a continuum of financial incentives to promote excellent outcomes for our members and reward you for those outcomes.


Incentives for high-quality care

Incentives for high-quality care

Our incentive program runs during the measurement period, January 1, 2023 through December 31, 2023. When you take part, you can earn incentives for providing high-quality, efficient care.  

How does the program work?

Our program is applicable to “qualifying claims,” which are:

  • Covered services provided within the measurement period
  • Unique to an enrolled Aetna Better Health® of Kansas member for a date of service
  • Billable code(s) included in Exhibit 1 Qualifying Services and Incentives
  • In a Paid Status on or before March 31, 2024

Key requirements for granting incentives

  • Only qualifying claims are eligible for incentive payment consideration. 
  • Participating provider panels must remain open to accepting members during the measurement period from January 1, 2023, through December 31, 2023. 
  • Rate-based measures are restricted to primary care providers (PCPs) whose tax identification number (TIN) denominator is 10 assigned members or greater.
  • A minimum number of assigned members are not required for the additional measures listed.  

We’ll determine the qualifying claim submission(s) eligible for incentive payment. If you’ve been approved to receive an incentive payment, we’ll mail you a check during the second quarter of 2024.

All members are eligible to be captured under this program except for the Children’s Mercy Pediatric Care Network (PCN) members (up to age 20), who are already managed by PCN and are living in these counties:

  • Douglas
  • Franklin
  • Johnson
  • Leavenworth
  • Miami

There are a few ways you can identify whether a member is part of the PCN. You can:

Call Provider Experience at 1-855-221-5656 (TTY: 711). You can call Monday through Friday, 8 AM to 5 PM.

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