Primary Care Flex Program

PC Flex Program overview

  • The ACO Primary Care Flex Model (Flex) is a new model from the Centers for Medicare and Medicaid Services Innovation Center (CMMI) within the Medicare Shared Savings Program (MSSP).
  • Accountable care organizations (ACOs) that participate in the model will jointly participate in MSSP and Flex.
  • Participating practices will receive monthly prospective primary care payments (PPCP), which are based on population.
  • The model will test whether improved payment for primary care will empower participating ACOs and their primary care physicians to utilize more innovative, team-based, person-centered, and proactive approaches to care and positively impact health outcomes, quality, and costs of care.
  • There is also a one-time infrastructure payment to the ACO.

Learn more about the PC Flex Program

Fee For Service Training

Attend one of the June training sessions to learn about Aledade's upcoming Fee For Service payments starting in July. Available dates and times for your practice are listed below.

Upcoming Payment Schedule:

Monthly PC Flex incentive payments for May and June will be processed at the end of each month. Updates on payment schedule frequency will be provided before July, when claim payments begin.

  • Anticipated payment release date: May 30, 2025*

*Banks have up to 48 hours from receipt of the payment to process. Please allow for the appropriate processing time for your institution when looking for posted payments.

Additional resources:

Monthly bulletins

 

Need help?

Key question of the month

Question

Answer

How do I locate my Explanation of Payment?

Practices can log into QuickCap to retrieve a copy of their Explanation of Payment. On the QuickCap home screen, go to Payment Processing > Claims EOB. You will then enter/search for your organization name and click on Retrieve Checks. This will bring up a list of recent checks that have been disbursed to your organization.

Would like to highlight a new question and archive the old ones in a way that the practices can access - labeled on the site as previous questions.

Greetings PC Flex Participants,

This newsletter contains key program information and action items related to your participation in the PC Flex program. Please note, not all action items may be applicable to all email recipients.

QuickCap Webinar Materials and Recordings
Thank you to all who were able to join and participate in the webinar sessions held last week. We appreciate your attention and engagement in the discussion! If you were not able to attend or would like to share the session recording and slides with others on your team, you can access those resources below.

Webinar recording

Webinar slide deck

Upcoming QuickCap Access for New and Existing Users

Aledade is provisioning access to QuickCap for all users who submitted an access request earlier this year. This includes users who were not indicated as financial administrators.

Please review the following instructions to ensure users are able to access QuickCap:

If you don’t have an Aledade App Account:

  • You will receive two separate emails directly from Aledade: “Welcome to Aledade” and “Password Reset.”
  • Please follow the steps to reset your password and create an account for Aledade.
  • Once an account is created and the password is reset, use the following link, or copy/paste into your preferred browser, to access QuickCap: https://aledade.quickcap.net/

If you do have an Aledade App Account:

Don’t know if you have an Aledade App Account? If you do not receive a “Reset Password” email, it is likely you do! Attempt to log into QuickCap and input your known credentials.

Upcoming Key Dates & Deadlines

Item

Date / Deadline

CMS Fee Reduction Agreement (FRA)

March 27, 2025

Advanced Shared Savings Payment Activity Collection Form

March 27, 2025

Input of Banking Information

February 25, 2025 (If you are unable to update banking information, your practice will not receive eligible payments issued Feb 28. The next payment will be processed close to the end of March)

 

If you have any questions or concerns, please submit a ticket via the Customer Service portal within the QuickCap platform. If you are unable to submit a ticket or do not yet have access to QuickCap, you can reply to this email directly.

You can also visit https://aledade.com/pc-flex-support/ for the latest information and updates.

Regards,

Aledade PC Flex Support Team

 

 

Greetings PC-Flex participants,

We have important updates to share with you regarding payment distributions, upcoming training sessions and key CMS requirements.

Upcoming PC Flex training sessions

As we prepare for the full release of the QuickCap vendor portal, we invite you to attend a training session on navigating the platform and its reports. These sessions will ensure you are equipped to use the portal efficiently.

Please register at your earliest convenience to receive the session invite. If you are unable to attend live, all sessions will be recorded, and materials will be shared afterward.

Sessions (click the link to sign up):

Upcoming payment update

We are excited to begin payments through the Flex program. Flex provides an opportunity to turbo charge MSSP ACOs during the performance year by enhancing the cash flow to practices and to the ACO in more innovative and proactive ways.

In the next two weeks, you will notice the first $50 incentive payments for AWVs and TCMs for patients assigned to Flex, intended to support a more comprehensive and impactful approach to these visits.

What's next: Preparing to receive your Advanced Shared Savings Payment

CMS will provide a one-time Advance Shared Savings Payment to each Flex ACO. Aledade will distribute each practice’s portion based on LUM. To comply with CMS requirements, Aledade is required to report on how the payments are being allocated. We will be sending you a list of compliant activities you can allocate this money toward, and ask that you let us know which activities you are allocating funds to. Once we have your list, we will release these funds.

Finally, the ACO is also committed to ensuring its portion of the funds goes to greater innovation in full compliance with CMS requirements. You will be seeing more wrap-around services targeted at even greater ACO success through healthier patients.

Aledade is committed to making Flex a success by operating the Flex program with timely and accurate payments with minimal practice workflow disruptions. We will leverage Flex to do more in the ACO for patients.

Action required: CMS Fee Reduction Agreement deadline

In the coming weeks, Aledade will be emailing the CMS Fee Reduction Agreement (FRA) via DocuSign for signatures. This agreement was referenced in a placeholder in the Flex Practice Agreement Amendment. The deadline to execute the agreement is March 31.

Why the FRA is necessary for Flex:

  • Starting July 1, practices in Flex will submit claims as usual to CMS, and CMS will zero out (or “reduce”) the claims for primary care services billed and delivered by the ACO's primary care clinicians to Flex assigned patients.
    • Flex assigned patients include those attributed to MSSP in PY0.
  • The codes that will be zeroed out are those core primary care E&M services provided by primary care physicians and select non-physician practitioners (NPs, PAs, CSNs who are not specialists).
  • CMS will adjudicate all claims as usual, and through QuickCap, Aledade will pay these claims at 100% FFS/PPS/AIR.

Next steps

Please keep a look out for the FRA DocuSign and Roster Appendix, being sent in the coming weeks.

If you have any questions or concerns, feel free to reply directly to this email or contact us at pc-flex-customer-service@aledade.com. You can also visit https://aledade.com/pc-flex-support/ for the latest information and updates.

Regards,

Aledade PC Flex Support Team

 

 

With the form completed, Aledade is ready to take the next step in ensuring that payments related to the Primary Care Flex program are timely and accurate.

In order to ensure there are no payment delays associated with the program, we require your banking information. Please note, you were indicated within the QuickCap user access form as the designee for inputting your respective practice’s banking and/or financial information. If this is in error, please complete the following form again with the corrected information and select the checkbox at the bottom to indicate resubmission.

 

Call to Action

Complete the following steps to provide your primary care organization’s banking information in QuickCap, no later than Friday, January 24th, 2025. Any delays in completing this information will result in payment delays associated with the program.

 

To provide the required banking information, please follow the steps listed below

  1. Log into the QuickCap Portal using this link.
  2. Once logged on, click on “My Profile” in the top righthand corner.

image-28-1 (1)
 
3. Then navigate to the “Banking Information” tab, and select the small “Edit” button.
 
Snag_39fff072 (2)
 
4. Finally, input the required banking information.
 
Snag_39fffb9e-1 (1)
 

How does Primary Care Flex work?

  • January 1 – June 30, 2025: No changes to fee-for-service (FFS) payments will occur for your practice during this period.
  • Enhanced Payments Begin January 1, 2025: Aledade will provide an additional “Enhanced Payment” based on your participation in Annual Wellness Visits (AWVs) and Transitional Care Management (TCMs). These activities are already integral to your practice workflows, offering an opportunity to further benefit from your existing efforts.
  • Starting July 1, 2025: Fee-for-service payments for your attributed patients will transition to Prospective Primary Care Payments (PPCP). This change will not result in revenue loss for your practice, and you may see a net gain due to the incentive payments tied to Flex.
 
Timeline What to Expect What Do I Need to Know or Be Prepared For?
Beginning Jan. 1, 2025 AWVs and TCM visits that are done starting January 1 are eligible for the incentive payments for attributed patients. These payments will be $50 for all ACOs.

No changes to Primary Care Organizations operations; continue to perform services and bill as normal.

Practices will be provisioned access to QuickCap vendor portal with their Aledade credentials to access reporting related to their PC-Flex attributed population.

Details related to the portal, training, or other resources can be found in this email.
Beginning July 1, 2025

Enhanced Incentive payments will continue as described above.

Aledade will pay primary care organizations directly for their Flex attributed patient population; all claims submitted to CMS for activity after July 1st, for Flex attributed patients, will instead be paid by Aledade on a weekly basis.

These payments will mirror the CMS payments exactly, and cash flows will remain steady.

Aledade is partnering with a clearinghouse to route 835 remittance files to each practice directly.

Practices will receive an 835 file for each claim that Aledade pays on behalf of CMS, with all the original claim information for payment posting.

Practices will retain access to QuickCap vendor portal to access and download 835s directly, monitor their incoming payments and manage their A/R.

 

 

Quick Links

User Access Form Submission

QuickCap Portal Access

If you have any questions or concerns, feel free to reply directly to this email or contact us at pc-flex-customer-service@aledade.com.

 

Connect with us!

Start planning your value-based care journey now

Thousands of your primary care peers are choosing Aledade as their value-based care partner. Let our experts show you why.