December 08, 2016
Area(s) of Interest: Payor Issues and Reimbursement Practice Management
United Healthcare (UHC) recently notified physicians that it will be introducing a new commercial narrow network PPO product, Navigate, to the California marketplace effective January 1, 2017. Due to an operational error, the notice issued to California providers inadvertently referenced United Healthcare of Nebraska, which is also launching the Navigate product. UHC has since issued a corrected notice.
UHC says the Navigate plan is its most recent effort at providing a reduced-cost health care option to employers. This network offers access to a significantly narrowed network of PPO physicians, while requiring patients to coordinate and obtain prior referral for specialty care from their selected primary care physician.
The Navigate network of providers will mirror United’s existing Core provider network, with the exclusion of providers and hospitals from the Sutter Health network. The terms of each physician’s UHC base contract, including compensation, will apply to the new Navigate plan. According to United Healthcare, factors influencing a physician’s participation in the Navigate plan network mirror those of the Core product, including cost, quality and efficiency criteria. For an overview of the Navigate plan, click here.
In addition to the narrowed Navigate provider network, UHC will be utilizing the W500 wrap network, which will include the remaining PPO providers not selected to participate in the Navigate provider network. Similar to Core, Navigate patients can only access physicians in the W500 network for emergency services and related admissions, urgent care services and other prior approved services.
In August 2016, UHC sent notices, including a unilateral contract amendment, to physicians who were automatically opted into the W500 product. The terms of the underlying UHC PPO contract will apply to those physicians being opted into the W500 product for Navigate.
As always, physicians are encouraged to carefully review all proposed amendments to payor contracts. Remember, you do not have to accept substandard contracts that are not beneficial to your practice.
Physicians who are unsure whether or not they are affected by this change, those who have general questions about the amendment or those who wish to dispute their performance rating for participation in the Navigate plan network can contact UHC Network Management at (866) 574-6088.