2022 Medicaid Pediatric Healthcare Recovery Program

Medicaid ONLY Child and Adolescent Well Care Visit Measure Standards and Specs: 2022 Medicaid Pediatric Healthcare Recovery Program Measure Description and Payment Schedule (to be linked) and NCQA HEDIS measure

If you need to resubmit Baseline data (for whatever reason), contact Carolyn Karner @ckarner@ctc-ri.org.

Reporting Period

Practice Name

General Information

Group NPI (type II)

Address Line 1

Address Line 2

City/Town

Zip Code

	First Name	Last Name	Email
Primary Contact

	First Name	Last Name	Email
Provider Champion

	Numerator	Denominator	Rate (%)
3-11 years	Numerator must be less-than or equal to the Denominator		Numerator must be less than Denominator
12-17 years	Numerator must be less-than or equal to the Denominator		Numerator must be less than Denominator

Practice's composite well child visit performance Rate (%) =

	1st HEDIS Target (April) (%)	1st improvement target-April-(2.5% above baseline performance)	Final HEDIS 75th percentile weighted Target (July) (%) =	Final improvement Target-July-(5% above baseline performance)
	Numerator must be less than Denominator	Numerator must be less than Denominator		Numerator must be less than Denominator

April Payout Status =

Patients to Goal for July Reporting

~ # of patients to meet Final HEDIS target (July)


OR

~ # of patients to meet 5% improvement target

Final Payout Status =

Numerator must be less than Denominator

Contact Information