Program payments for each eligible provider are calculated using the following methodology.
Quality score: A quality score for each program measure is computed for each provider by determining:
Numerator = Eligible members meeting criteria
Denominator = Total members eligible
Numerator ÷ Denominator: The individual provider’s quality score for each program measure
CHILDHOOD IMMUNIZATIONS – COMBO 10
The percentage of children 2 years of age who meet the combination 10 criteria on or before their second birthday:
– (4) DT aP* vaccinations
– (3) IPV* vaccinations
– (1) MMR vaccination
– (1) VZV vaccination
– (3) HiB* vaccinations
– (3) Hepatitis B vaccinations
– (4) PCV* vaccinations
– (1) HepA vaccination
– (2 or 3) RV* vaccinations
– (2) Influenza** vaccinations
*Vaccinations administered prior to 42 days after birth are not counted as a numerator hit.
**Vaccinations administered prior to 180 days after birth are not counted as a numerator hit.
Numerator: The number of children who completed vaccinations as defined above
Denominator: The eligible population
Target: 63%
Payout: $400 per Combo 10 completed for each eligible member