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Last Modified: 7/23/2014 Location: FL, PR, USVI Business: Part B

2014 Primary Care Incentive Program (PCIP) payments

The Centers for Medicare & Medicaid Services (CMS) provides contractors with a list of the national provider identifiers (NPIs) of the eligible primary care practitioners around the beginning of the incentive year. If a claim for a primary care service is submitted by a physician or group practice, the primary care professional service must be reported under a practitioner with a qualifying NPI in order for the service to qualify for the incentive payment.
Eligible providers for payment year 2014 are included in the 2014 PCIP eligibility file.zip compressed file file. To locate a provider, open the file, select Ctrl+F (“find”) and enter an NPI

PCIP eligibility file record layout

FIELD NAME
START/END POSITION
PIC
COMMENT
Filler
1-6
X(6)
Value spaces (in the future, this field may contain the carrier/MAC number).
NPI
7-16
X(10)
Left justified. NPI of the provider who will be paid the primary care incentive.
Filler
17-17
X(1)
Value spaces
Incentive Payment Year
18-21
X(4)
CCYY (quarterly Primary Care Incentive payments are made using claims data from this year).
Filler
22-22
X(1)
Value spaces
Qualifying Year
23-26
X(4)
CCYY (claims history data from this year was used to determine if the NPI qualified for the Primary Care Incentive).
Filler
27-46
X(20)
Value spaces

Additional information

The Centers for Medicare & Medicaid Services (CMS) has compiled a list of questions and answers to respond to the inquiries it has received on the primary care incentive payment program (PCIP).
the MLN Matters article SE1109 external pdf file also contains details on and links to several articles published by CMS containing information on Section 5501(a) of The Affordable Care Act, which provides for an incentive payment for primary care services furnished on or after January 1, 2011, and before January 1, 2016, by a primary care physician or nonphysician practitioner (NPP). These articles explain how the program would pay the incentive payment to eligible primary care physicians and NPPs, including newly enrolled physicians and NPPs, who furnish primary care services in various settings.
Click here pdf file for more information regarding PCIP payments.

First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.