Important updates to UnitedHealth Premium program designation
Program updates: Tier 1 physicians to include previous version 13 and newly released version 14 Premium Care Physicians, and more.
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The UnitedHealth Premium® program provides physician designations based on quality and cost efficiency criteria to help members make more informed choices for their medical care. UnitedHealth Premium designation updates take place prior to open enrollment to allow members to verify a physician’s premium status in the upcoming calendar year before enrolling in a Tiered Benefits plan. The claims data used is for dates of service from Jan. 1, 2017, to Feb. 29, 2020, which pre-dates the COVID-19 emergency.
Updated designation effective dates
Designation changes for the version 14 refresh for Premium Care Physicians took effect on Sept. 24, 2021. Claims from physicians losing their Premium Care Physician designation in 2021 because of the version 14 refresh will continue to pay at Tier 1 through the end of 2022, except for those physicians who did not meet the Premium program’s quality criteria in version 14.
Previously, for future year tiering, directories would have only shown version 14 Premium Care Physicians as having Tier 1 status. Provider directories will now show both version 14 and version 13 as Tier 1 in future year tiering tools, subject to the conditions explained above.
In January 2022, version 13 and 14 Premium Care Physician designation will equal Tier 1, except if a physician failed to meet the quality criteria in version 14. If members visit a version 13 Premium Care Physician that lost their Tier 1 status in January 2022, UnitedHealthcare will provide a one-time Tier 1 status claims processing to help in this transition.
Version 13 Premium Care Physicians who did not fail to meet quality in version 14 will continue to have Tier 1 status throughout 2022. Refer to the chart below for full updates.
Note: There will be no changes to any iconography or text that is displayed when members search for Premium Care Physicians or Tier 1.
|Member display dates||Tier 1 display* on myuhc.com||Tier 1 claim processing*|
|Sept. 24, 2021, through Dec. 31, 2021||Version 13 and 14 Premium Care Physicians, except those who do not meet Premium Quality criteria in version 14||Version 13 and 14 Premium Care Physicians, including those who do not meet Premium Quality criteria in version 14|
|Beginning Jan. 1, 2022||Version 13 and 14 Premium Care Physicians, except those version 13 physicians who do not meet Premium Quality criteria in version 14||
Version 13 and 14 Premium Care Physicians, except those version 13 physicians who do not meet Premium Quality criteria in version 14
During January 2022 only, members will receive a one-time claim adjustment for version 13 providers who have lost their Tier 1 status due to not meeting quality in version 14. If the member continues to utilize the physician, they will not receive another claim adjustment.
*Tier 1 standards include all Premium Care Physicians, specialists and in-network oncologists.
The Premium program evaluates 16 specialties, representing 47 credentialed specialties. The were no changes in 2021 to these credentialed specialties.
Updated Tier 1 providers in 2022
Anyone, including prospective members, can see if a provider will be Tier 1 in 2022 by viewing one of the tiered guest directories on myuhc.com®, updated on Oct. 1, 2021. Under this approach, the user will simply select the appropriate tiered product and the year in which they are seeking services and can search for a Tier 1 provider by looking for the blue-dot icon.
- Premium tiered open access plans (Choice Premier)
- Premium tiered open access with hospital tiering (Choice Advanced)
For more information, please contact your broker or UnitedHealthcare representative.
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