June 28, 2017
Area(s) of Interest: Commercial Payors Practice Management
In its June Network Bulletin, UnitedHealthcare (UHC) announced that the next iteration of its Premium Designation assessment results will be sent to physicians in early July. These results will be released publicly via the payor's online physician directory beginning September 6, 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 46 credentialed sub-specialties will again be ranked by UHC on both national and specialty-specific measures for quality and various cost-efficiency benchmarks.
UHC says 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, 2014, through February 28, 2017. Physicians who wish to dispute their assessment results before they are posted publicly in September 2017 must submit a reconsideration request through the UnitedHealthcare Online website no later than August 7, 2017. 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 September 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 UHC at (866) 270-5588. Practices that are unable to obtain answers to their questions or resolve the issue with UnitedHealthcare directly are encouraged to contact the California Medical Association at (800) 786-4262.