Beginning July 1, 2019, new and renewing business will no longer have access to the Shared Savings Program in Kentucky.
Small businesses on PRIME and key accounts for both ACIS and PRIME will receive this notice. This affects fully insured Kentucky-sitused commercial employer groups on UNET with the Non-Emergent Extended Non-Network Reimbursement Program (ENRP).
Claims will now be paid using ENRP or MNRP (Maximum Non-Network Reimbursement Program) if applicable. These may include:
- Non-network providers
- In states that allow Non-Emergent ENRP
- Members in fully insured plans
- Claims that are ENRP eligible
Member impact may include balance billing from the non-par provider after ENRP or MNRP is applied, according to the member benefit plans.
What this change means
Processing claims at ENRP or MNRP rates rather than discounted SSP rates will help decrease UnitedHealthcare’s non-network spending and provide a greater financial incentive for members to use network providers. It will also help increase incentives for non-network providers to join UnitedHealthcare’s network. This program change will not affect if a claim is paid at the network or non-network benefit level. ENRP or MNRP will be applied depending on the benefit determination.
Impacted members with frequent non-network utilization of Shared Savings Program health plan professionals and facilities will be notified of these upcoming changes approximately 30 days prior to their renewal date.
Health plan ID cards
All impacted, fully insured Kentucky-sitused members will receive updated health plan ID cards — without the Shared Savings Program logo — as their group renews, starting in July 2019.
For more information, please contact your UnitedHealthcare representative.