UnitedHealthcare to issue new Premium Designation physician results 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. July 21, 2017 Managed Care United Healthcare 0 0 Comment Read More »
United Healthcare delays 2016-2017 Premium Designation physician results United Healthcare (UHC) has indicated that distribution of its 2016-2017 Premium Designation assessments will be delayed to December 30, 2016, with the results released to the public on March 1, 2017. UHC had previously announced that the next iteration of its Premium Designation assessment results would be sent to physicians in early November 2016, with the results to be released publicly via the payor's online physician directory on January 4, 2017. Physicians who encounter problems with their physician assessment reports or who have concerns regarding their Premium Designations can contact UHC at (866) 270-5588. Practices that are unable to obtain answers to their questions or resolve the issue with United Healthcare directly are encouraged to contact the California Medical Association at (800) 786-4262. Taking these proactive steps to protect your practice by preventing denials, delays in payment and disgruntled patients goes a long way toward ultimately saving time and money. December 21, 2016 Managed Care United Healthcare 0 0 Comment Read More »
United Healthcare to introduce Navigate, new narrow network product, in 2017 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. December 14, 2016 Managed Care United Healthcare 0 0 Comment Read More »
United to issue new 2016-2017 Premium Designation physician results In its October Network Bulletin, United Healthcare (UHC) announced that the next iteration of its Premium Designation assessment results will be sent to physicians in early November. These results will be released publicly via the payor's online physician directory beginning January 4, 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 47 credentialed sub-specialties will again be ranked by UHC on both national and specialty-specific measures for quality and various cost-efficiency benchmarks. According to UHC, the specialty of ophthalmology, while included in previous Premium Designation assessments, will be excluded from the 2017 assessment due to insufficient data. According to UHC 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, 2013, through March 31, 2016. Physicians who wish to dispute their assessment results before they are posted publicly in January 2017 must submit a reconsideration request through the United Healthcare Online website no later than December 5, 2016. 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 mid-year 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 United Healthcare at (866) 270-5588. Practices that are unable to obtain answers to their questions or resolve the issue with United Healthcare directly are encouraged to contact CMA at (800) 786-4262. November 16, 2016 Managed Care United Healthcare 0 0 Comment Read More »
Physicians encouraged to verify CHPI data by November 11 Earlier this month, approximately 13,000 physicians in California received their individual quality measurement scores for the second cycle of the California Healthcare Performance Initiative System (CHPI) quality rating program. Physicians can review and verify the accuracy of the data used to calculate their scores through the CHPI online portal through November 11, 2016. The program rates physicians using claims data from Medicare fee-for-service, Anthem Blue Cross, Blue Shield of California and United Healthcare. This claims data includes both commercial and self-funded health plan data from HMO, PPO, POS and Medicare Advantage products. The individual quality measurement scores were based on claims data for patient care provided January 1, 2012, through December 31, 2014. Physicians were assigned a star rating of one to four stars, based on where they fall as a percentile within a “peer group,” for each measure, as well as a composite score. Physicians who wish to verify the accuracy of the data used to calculate their scores can do so through the CHPI Review and Corrections portal. To access the review and correction portal, physicians will have to register using their username and registration token – both listed at the top left of each page of the report. Once registered, you will receive a confirmation email with instructions to create a password. According to CHPI, it will treat the data as complete and accurate if no corrections are made. This means that even if a physician has not logged into the online portal during the review and correction period, CHPI will still publish the physician's data. Physicians who review their data and identify errors have until November 11, 2016, to report any discrepancies via the CHPI online portal. At the close of the physician review and correction period, discrepancies will be evaluated and corrected, with the results recalculated prior to the public release of the ratings. After November 11, the review and correction period will close, and physicians will be unable to review or report discrepancies. CHPI has advised the California Medical Association (CMA) that in addition to publishing the ratings publicly, it will also release an aggregated data file to the aforementioned participating plans following the review and correction period later this year. CMA inquired as to how the data would be utilized by the plans, but as of the time of publication, it was not known. For more information on the CHPI rating methodology, visit the CHPI website at www.chpis.org. CHPI has also published an FAQ on its rating program and a step-by-step review and corrections tutorial. Physicians who did not receive a letter but would like to confirm whether they are included in CHPI’s rating results can use the CHPI physician lookup at https://provider.medinsight.milliman.com/clients/CHPI/Public/Lookup. If you have questions or concerns about the CHPI rating results, you may email chpicorrections@pbgh.org and you should receive a response within 48 hours. Physicians who do not hear back within 48 hours or who identify a high volume of discrepancies in the data used to calculate their scores are encouraged to contact CMA at (916) 551-2061 or jwilliams2@cmanet.org. CMA will also be hosting a webinar on October 5 where CHPI staff will provide an overview of the quality rating project, along with step-by-step instructions on how physicians can review their data for accuracy before the quality scores are published. The webinar is free to CMA members ($99 for non-members). To register, visit the CMA website at www.cmanet.org/events. September 22, 2016 Managed Care, Medicare Medicare, Quality of Care, United Healthcare, Anthem Blue Cross, Blue Shield, CHPI 0 0 Comment Read More »
United Healthcare fails to provide proper notification on rollout of clinical data submission protocol The California Medical Association (CMA) is concerned that United Healthcare (UHC) failed to properly notify physicians before implementation of its Clinical Data Submission Protocol. Although California law (California Insurance Code §10133.65 and Health & Safety Code §1375.7) requires payors to provide contracted physicians with the 45 business days’ advance notice of any material contracting changes, UHC's only notification to physicians about this new protocol was in its Network Bulletin. First introduced in 2015, the program originally targeted only Medicare benefit plans and required physicians to submit all laboratory test results for UHC Medicare patients. The expansion of the program will require practices to submit laboratory tests for all UHC Medicaid and commercial benefit plans. UHC has stated, however, that it will help practices establish the transmission method that works best with their current capabilities. At the request of CMA, UHC delayed the expansion of its Clinical Data Submission Protocol in California. Originally scheduled to take effect July 1, 2016, the expansion was pushed back until September 2. However, CMA believes UHC is not compliant with state law as it has not formally notified all affected physician practices of changes to the protocol. CMA is evaluating its next steps and will update physicians when additional information is available. While UHC lauds the sharing of clinical patient data as an opportunity to support quality and cost-effective patient care, CMA is also concerned about the administrative burden of the protocol and the impact on physician practices. For more information about the protocol and requirements for submitting data to UHC, physicians should refer to the updated Clinical Data Submission Protocol Frequently Asked Questions and Methods of Clinical Data Exchange, or contact either the UHC Provider Call Center at (877) 842-3210 or their local UHC Network Account Manager or Provider Advocate. Click here to view the letter to UHC. September 13, 2016 Managed Care, Medicare United Healthcare, Medicare 0 0 Comment Read More »
UHC to require prior authorization for select outpatient surgical procedures As indicated in its July 2015 Network Bulletin, United Healthcare (UHC) will begin requiring prior authorization for certain surgical procedures done in a hospital outpatient setting effective October 1, 2016. The new prior authorization requirement includes procedure codes in cardiovascular, cosmetic and reconstruction, ophthalmology, and ENT (ear, nose and throat) specialties. Prior authorization will not be required to perform the identified procedures if done in an in-network ambulatory surgery center. For a complete listing of procedures requiring prior authorization, physicians can access the Prior Authorization for Outpatient Surgical Procedures FAQ on the UHC website. Practices may submit prior authorization requests to UHC via the www.UnitedHealthcareOnline.com website, by calling (877) 842-3210 or by faxing the request to (866) 756-9733. For questions or concerns regarding this process, physician practices should contact UHC Network Management at (866) 574-6088. August 9, 2016 Managed Care United Healthcare, Preauthorization 0 0 Comment Read More »
United Healthcare extends clinical data submission deadline to Sept. 2 At the request of the California Medical Association (CMA), United Healthcare (UHC) has delayed the expansion of its Clinical Data Submission Protocol in California. Originally scheduled to take effect July 1, the expansion will now be pushed back until September 2. First introduced in 2015, the program originally targeted only Medicare benefit plans and required physicians to submit all laboratory test results for UHC Medicare patients. The expansion of the program will require practices to submit laboratory tests for all UHC Medicaid and commercial benefit plans. For more information about the protocol and requirements for submitting data to UHC, physicians should refer to the updated Clinical Data Submission Protocol Frequently Asked Questions and Methods of Clinical Data Exchange. While UHC lauds the sharing of clinical patient data as an opportunity to support quality and cost-effective patient care, CMA has expressed concerns about the administrative burden, impact on physician practices and proper notice to physicians. UHC has stated, however,that it will help practices establish the transmission method that works best with their current capabilities. For more information or to speak to the UHC clinical data team, contact the UHC Provider Call Center at (877) 842-3210 or your local Network Account Manager or Provider Advocate. July 14, 2016 General Medicare, United Healthcare, Clinical Laboratories 0 0 Comment Read More »
United Healthcare to post patient satisfaction ratings in provider directory United Healthcare (UHC) announced in its March 2016 Network Bulletin that it has incorporated Healthgrades patient satisfaction ratings into its provider directory search tool on its myUHC.com website. Healthgrades is an independent company that allows patients to rate their satisfaction with their health care providers. UHC reports it is incorporating the patient satisfaction ratings into its provider directory to increase patient awareness and education regarding patient satisfaction and quality of care standards. Patients will rate providers – including physicians, nurse practitioners and physician assistants – on their satisfaction level for each of the following nine categories: Likelihood of recommending doctor to family and friends Level of trust in provider’s decisions How well provider explains medical condition(s) How well provider listens and answers questions Spends appropriate amount of time with patients Ease of scheduling urgent appointments Office environment, cleanliness, comfort, etc. Staff friendliness and courteousness Total wait time in waiting room and exam room Ratings are measured on a scale of one to five stars, with five stars being the highest rating. Providers must have at least one patient review to have their results published; individual patient ratings will remain on the provider’s Healthgrades profile for two years. UHC has created an FAQ document regarding the incorporation of the Healthgrades patient satisfaction ratings. For more information on the program, providers should contact the UHC Health Care Measurement Resource Center at (866) 270-5588. April 12, 2016 General United Healthcare 0 0 Comment Read More »
UHC to require prior authorization for select musculoskeletal and pain management procedures As indicated in its January 2015 Network Bulletin, United Healthcare (UHC) will begin requiring prior authorization for certain additional musculoskeletal and pain management procedures effective April 4, 2016. Included in the new prior authorization requirement are various arthroscopy procedures, spine-related surgeries, neurostimulators for back pain and certain foot surgical procedures. For a complete listing of procedures requiring notification, physicians can access the Advance Notification Requirements on the UHC website. Prior authorization will be required for services performed in all places of service settings, including inpatient/outpatient hospitals, ambulatory surgery centers and office locations. Practices may submit prior authorization requests to UHC via the www.UnitedHealthcareOnline.com website, by calling (877) 842-3210(877) 842-3210 FREE or by faxing the request to (866) 756-9733 FREE. For questions or concerns regarding this process, physician practices should contact UHC Network Management at (866) 574-6088 FREE. Call Send SMS Call from mobile Add to Skype You'll need Skype CreditFree via Skype February 9, 2016 General, Managed Care Preauthorization, United Healthcare, Pain Medicine 0 0 Comment Read More »
