UnitedHealth Premium program designations and updates effective Sept. 25

Designation updates for the UnitedHealth Premium® program take place prior to open enrollment to allow members to verify a physician’s Premium status in the upcoming calendar year. This year’s refresh of the Premium program will move forward as planned. Claims data used will be for dates of service from Jan. 1, 2017, to Feb. 29, 2020, which pre-dates the President’s COVID-19 national emergency proclamation.

Due to the impact of COVID-19 on 2020 claims data, new Premium designations will remain in effect for 2 years, through the end of 2022. This will result in added stability and decreased disruption.

Designation effective date
Designation changes will take effect Sept. 25. Within a week of the effective date, designations will display in provider directories such as myuhc.com® and related mobile applications. Claims from physicians losing their Premium Care Physician designation will continue to pay at Tier 1 through the end of 2020.

Member display dates Tier 1 display* on myuhc.com Tier 1 claim processing*
Now through Sept. 24, 2020 Version 12 Premium Care Physicians Version 12 Premium Care Physicians
Sept. 25, 2020, through Dec. 31, 2020 Versions 12 and 14 Premium Care Physicians, except those who do not meet Premium Quality criteria in version 12 Version 12 and 13 Premium Care Physician, except those who do not meet Premium Quality criteria in version 12
Beginning Jan. 1, 2021 Version 13 Premium Care Physicians

Version 13 Premium Care Physicians

During January 2021 only, members will receive a one-time claim adjustment for version 12 providers who have lost their Tier 1 status. If the member continues to utilize the physician, they will not receive another claim adjustment.

*Tier 1 includes all Premium Care Physicians, specialists and network oncologists.

Newly eligible specialties

Physicians with geriatrics as their primary credentialed specialty are now eligible for a Premium program evaluation within the Premium specialty of Internal Medicine.

Tiering availability in St. Louis
Tiered Benefits plan restrictions have been removed for self-funded (ASO) business only in the St. Louis market. Effective Jan. 1, 2021, Tiered Benefits plans may be sold, and membership may reside in the St. Louis market for ASO business. This applies to UnitedHealthcare and UMR self-funded customers.

Tiered Benefit plan selling restrictions remain in place for all fully insured business. This means no fully insured Tiered Benefit plans can be sold – and no membership can reside in the St. Louis market – with the exception of:

  • Place-of-Service Differential benefits
  • Preferred Lab tiering benefits

Tiered Benefits provider search

Within the week following Sept. 25, any current member who authenticates on myuhc.com can find a provider, click on the physician’s name and see if they have the two-heart Premium Care Physician symbol, designating Tier 1 status for 2021.

New pre-member search for Tier 1 providers
Anyone, including prospective members, can see if a provider will be Tier 1 in 2020 by viewing one of the below pre-member sites, which will be updated by Oct. 1, 2020. Under this approach, users can simply select the 2020 plan year and search for a Tier 1 provider by looking for the blue-dot icon.

For more information please contact your UnitedHealthcare representative. 

Footnotes

The UnitedHealth Premium® designation program is a resource for informational purposes only. Designations are displayed in UnitedHealthcare online physician directories at myuhc.com®. You should always visit myuhc.com for the most current information. Premium designations are a guide to choosing a physician and may be used as one of many factors you consider when choosing a physician. If you already have a physician, you may also wish to confer with him or her for advice on selecting other physicians. You should also discuss designations with a physician before choosing him or her. Physician evaluations have a risk of error and should not be the sole basis for selecting a physician. Please visit myuhc.com for detailed program information and methodologies.