November 09, 2016
Area(s) of Interest: Commercial Payors Payor Issues and Reimbursement
In its October Network Bulletin, United Healthcare (UHC) announced that the next iteration of its Premium Designation assessment results will be sent to physicians in early November. These results will be released publicly via the payor's online physician directory beginning January 4, 2017.
Physicians within 16 specialties (allergy, cardiology, ENT, endocrinology, family medicine, gastroenterology, general surgery, internal medicine, nephrology, neurology, neurosurgery, OB/GYN, pediatrics, pulmonology, rheumatology and urology) and their 47 credentialed sub-specialties will again be ranked by UHC on both national and specialty-specific measures for quality and various cost-efficiency benchmarks. According to UHC, the specialty of ophthalmology, while included in previous Premium Designation assessments, will be excluded from the 2017 assessment due to insufficient data.
According to UHC physicians meeting or exceeding the benchmarks will be identified with a Premium Designation notation on their physician profiles, marketed to UHC enrollees through its online physician directory. UHC also offers employers the ability to select products that offer incentives, such as lower copays or coinsurance, for enrollees who see physicians with a Premium Designation.
The latest assessment is based on claims data from January 1, 2013, through March 31, 2016. Physicians who wish to dispute their assessment results before they are posted publicly in January 2017 must submit a reconsideration request through the United Healthcare Online website no later than December 5, 2016. A Reconsideration How-to Guide is available on the UHC website with instructions on preparing and submitting a reconsideration request. UHC will continue to allow requests for reconsideration until mid-year 2017, but updated distribution of Premium Designations is not guaranteed.
Physicians who encounter problems with their physician assessment reports or who have concerns regarding their Premium Designation can contact United Healthcare at (866) 270-5588. Practices that are unable to obtain answers to their questions or resolve the issue with United Healthcare directly are encouraged to contact CMA at (800) 786-4262.