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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.
  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.

In addition, some plans have additional providers that are excluded. For example:

  • South Florida Community Care Network d/b/a Community Care Plan excludes providers with less than six months participation in Community Care Plan’s Medicaid provider network.
  • Humana Medical Plan excludes primary care pediatric providers with a panel size of less than 200 Medicaid members for the measurement period and Obstetrician/Gynecologists (OB/GYNs) with less than 10 Medicaid deliveries during the measurement period.
  • Florida MHS, Inc. d/b/a Magellan Complete Care excludes OB/GYNs who did not have a delivery in the measurement period.

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: