Humana Reimburses for Physician
Recognition Programs

In an effort to support physicians who want to demonstrate their quality improvement efforts by participating in the National Committee for Quality Assurance (NCQA) physician recognition programs, Humana reimburses the application fees for a period of 24 months. The reimbursement, beginning in January 2008, is available for network physicians who apply for and achieve recognition through an NCQA Physician Recognition Program (PRP).

That reimbursement program is approaching its ending date of Dec. 31, 2009. Physicians who are interested in being reimbursed for their PRP program application through Humana must complete their application before January 2010.

Reimbursement for the NCQA physician recognition programs is capped at $1,000 for a physician group and $500 for an individual physician. Physicians who indicate on their applications that they are being sponsored by Humana at the time of application will receive a discounted application fee rate.

Available recognition programs
In 1997, the NCQA created the first PRP through a partnership between NCQA and the American Diabetes Association. Since that time, more than 10,000 of the nation's leading physicians and practices have earned the PRP distinction.

Today, NCQA offers four PRPs to physicians, including Diabetes PRP, Heart/Stroke PRP, Back Pain PRP, and Physician Practice Connections — Patient-Centered Medical Home Program. Participation in one or all of these programs demonstrates that a physician is using the latest clinical protocols so patients receive up-to-date care for these key conditions.

Physicians qualify for NCQA recognition by meeting rigorous standards and reviewing medical records to confirm the documentation is consistent with evidence-based guidelines. To participate, physicians obtain a survey tool from NCQA and enter the required data. The survey tool automatically scores the data and informs the physician if the data meets the recognition requirements.

Once recognition has been achieved, the network physician or physician group may submit the invoice for the application fee and proof of recognition to Humana for reimbursement. Physicians who indicate on the application that they are being sponsored by Humana at the time of application will receive a discounted rate.

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