Provider incentive program
Eligible providers may participate in the program
Your dedication to providing high-quality patient care is invaluable
At Carelon Health, we prioritize the delivery of high-quality patient care because we believe in its benefits. Our patient-centered care approach leads to fewer gaps in care, better health outcomes, and increased patient satisfaction. We're committed to partnering with provider groups like yours that share our commitment to exceptional patient care — and we're here to help you succeed in delivering it.
Incentive program components
Stars ratings
Requirement: 25-patient panel per year minimum by October for each measurement year.
Clinical1 2025 incentives:
5 stars (4.75 – 5.00 overall raw score): $200/patient
4.5 stars (4.25 - 4.74 overall raw score): $80/patient
4 stars (3.75 – 4.24 overall raw score): $50/patient
Pharmacy 2025 incentives:
9% or more on mail order rate: $5/patient per year
20% or more on mail order rate: $10/patient per year
85% or more on 90-day supply prescribed:
$5/patient per year15% or more on 100-day supply prescribed:
$10/patient per year
1 Independent monitoring measures can change year over year. Notification will take place by January 30 of current performance year.
Patient Annual Health Assessment Form (PAHAF)
Submit all PAHAFs through the provider portal .
If you do not have access to the provider portal, please contact: carelonhealth.providerrelations@carelon.com.
2025 incentives:2
Dates of service between
January–June: $300/patient per year for portal submissions
July–December: $200/patient per year for portal submissions
January–June: $200/patient per year for paper submissions
July–December: $100/patient per year for paper submissions
Accuracy bonus: A $10 bonus, per form, will be provided for achieving an 85% or greater accuracy (e.g., accurate and completed documentation) based on results of the coding review with a threshold of an 85% return rate.3
2 All submissions must be received within 90 days from dates of submission with corresponding claim received within 90 days of DOS. All 2025 PAHAF submissions must be received by January 9th, 2026.
3 Accuracy bonus is only available to provider groups who return 85% of their issued PAHAFs, as well as 85% accuracy rates. Accuracy bonus paid annually by April 1, 2026.
Patient experience
Requirement: 25-patient panel per year minimum by October for each measurement year.
2025 rewards:
- $20/patient per year.
- Year 1: Implement the patient experience survey and submit annual results for approval.
- Year 2: Demonstrate improvement in overall patient satisfaction.
- Year 3: Demonstrate improvement in CAHPS comparable metric. Consumer Assessment of
Healthcare Providers & Systems (CAHPS) metrics
The incentive program is a three-year program. Ongoing participants can receive additional bonuses:
- Year 2: If a provider received a payout for year one in all components (Stars, PAHAF, and Patient Experience), an additional 10% increase to the sum of the three component payouts will be applied to the year calculation.
- Year 3: If a provider receives a year 2 bonus, an additional 15% increase to the sum of the three components payouts will be applied to the year calculation.
Questions about patient experience bonuses?
Please review our Patient experience reference guide or contact patientexperience@carelon.com.
Questions about provider incentive bonuses?
Please contact carelonhealth.providerrelations@carelon.com.
