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Tier 1 and UnitedHealth Premium Physician Designation Refresh Effective March 30

February 7, 2017

Since its inception over ten years ago, UnitedHealthcare regularly evaluates eligible network physicians for inclusion in our UnitedHealth Premium® program and tiered benefits plans. The evaluation involves reviewing claims data to determine which physicians meet national industry guidelines for quality and local market benchmarks for cost efficiency. As a result, providers join and leave the program. This year, these changes will take place on March 30. We expect Tier 1 access to increase overall from the current level of 36 percent nationally to 42 percent.

Members in tiered benefit plans should be reminded:

  • That this change occurs this year in March.
  • To confirm that their physicians are in the program before scheduling appointments or seeing a physician after March 30.
  • If the physician has lost the Tier 1 status, the member may pay more for their services.

Print resources with suggested messaging are also availabe from your UnitedHealthcare representative upon request. 

Members in tiered plans can check status by looking for the Tier 1 “blue dot” status next to the physician’s name on our member web site,®.  This "blue dot" symbol is used to identify the over 350,000 physicians nationwide who provide the greatest value for our tiered benefit members. To minimize any disruption, we will honor the current Tier 1 status of physicians throughout 2017 for claims payment and provider directory display.  Only those physicians who do not meet quality criteria will be excluded from the March 30 release.

Changes in Ophthalmology and Addition of Oncology
As part of this refresh, two groups of specialists will be impacted. Based on the latest quality measures, the majority of ophthalmologists did not have enough data to assess their performance for the UnitedHealth Premium program. In 2017, ophthalmology is no longer an evaluated specialty and will not be included in Tier 1.  Responding to multiple client requests, all UnitedHealthcare network oncology specialists will be included for payment at the Tier 1 level in 2017. Self-funded clients can continue to pay for oncology services at the “Tier 2 level” through a special request.

These updates are part of our commitment to promote access to quality and affordable health care.  Efforts are underway to enhance the methodology to minimize disruption in the future as we continue to identify physicians for quality, cost efficiency and value.

Contact your UnitedHealthcare representative with any questions.