UnitedHealthCare Premium Designation Letters On Their Way to Physician Offices

The AMCNO has been informed that letters will be going out in September informing physicians of their Premium Designation status with UHC. There is a six-week “reconsideration period” after receipt of the letters. Physicians will have from 9/7/07 to 10/31/07 to provide self-reported, additional information on patient cases. Physicians that meet the quality and efficiency guidelines will receive a two star designation, and physicians that meet the quality guidelines will receive a one star designation. There could be several reasons why a physician would not meet either of the guidelines. There may be no record with UHC that they are board certified, or it could be that they did not have a sufficient number of claim volume. If a physician does not meet either of the guidelines they may go to UHC portal and check their cases to see if they can provide additional data. The physicians who receive only the quality rating but not the efficiency rating may also want to check and verify their data. Once again, physicians should note that once the letters are received they have a six week period when they may discuss/review the designation with UHC and get reevaluated before the information is published on the UHC website. Letters are scheduled to go out by September 7, 2007.