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MMA Physician Incentive Program (MPIP) Excluded Providers

The following providers are excluded from the MMA Physician Incentive Program:

  1. Non-Participating providers - Providers without a contractual arrangement with the plan to offer Included Services.  Please note that non-participating Emergency Department and Hospital Based Specialty Providers are not excluded from MPIP for services rendered to members under 21 years of age. Please click link below for additional information:

    Agency MPIP Model 2023-2024
     
  2. Federally Qualified Health Centers (FQHCs) - Services provided in an FQHC, regardless of whether or not the service is billed by the FQHC as an FQHC service or by the rendering provider using their own Medicaid ID.
  3. Rural Health Clinics (RHCs) - Services provided in an RHC, regardless of whether or not the service is billed by the RHC as an RHC service or by the rendering provider using their own Medicaid ID.
  4. County Health Departments (CHDs) - Services provided in a CHD, regardless of whether or not the service is billed by the CHD as a CHD service or by the rendering provider using their own Medicaid ID.
  5. Medical School Faculty Plans – Services provided in this plan may not be included in the MMA Incentive Program, regardless of whether or not the service is billed by the Medical School Faculty Plan as a plan service or by the rendering provider using their own Medicaid ID.
  6. Public Hospital Physicians participating in the Public Hospital Physician State Directed Payment Program - Includes primary care and specialty services provided by physicians employed by public hospitals.  The setting can be the hospital (IP, OP, ED) or a primary care/specialty care office practice. 

For a comprehensive summary of the 2023-2024 Agency MPIP Model requirements, please review the Agency’s MPIP Model 2023-2024 MPIP webpage.

For a comprehensive summary of each plan’s MPIP, including any and all provider exclusions, please review the Plan Program Summaries for each year of MPIP implementation:

MMA Physician Incentive Program (MPIP)