01/2020: UnitedHealthcare NexusACO® Benefit Plans Will Expand Access in 2020

Membership in the UnitedHealthcare NexusACO benefit plans is continuing to grow. Starting Jan. 1, 2020, even more members will have access to the UnitedHealthcare NexusACO plans.

UnitedHealthcare NexusACO is an accountable care organization (ACO)-focused tiered product. The NexusACO benefit plan designs encourage members to receive their care from the Tier 1 providers for the lowest level of cost sharing. Nationally, ACOs in certain markets have been selected to be included in Tier 1 for the UnitedHealthcare NexusACO benefit plans. In markets where ACOs are not yet featured for UnitedHealthcare NexusACO, Tier 1 is made up of UnitedHealth Premium® Care physicians. Members still have access to our broader network of care providers and facilities, but at a higher level of cost sharing.

Tier 1 image

Tier 1 care providers will have the Tier 1 graphic by their name in the UnitedHealthcare NexusACO care provider directory at UHCprovider.com > Menu > Find a Care Provider > NexusACO Care Provider Directory.

UnitedHealthcare NexusACO Tier 1 care providers are:

  • ACO care providers, supplemental care providers and selected oncologists in areas where there’s a featured ACO
  • Premium Care physicians in the UnitedHealth Premium® program and oncologists in areas without a featured ACO

Health Plan Key Features

UnitedHealthcare NexusACO includes two benefit plans – NexusACO R and NexusACO OA – and both require that the member select a primary care physician (PCP).  

NexusACO R requires referrals.

NexusACO OA doesn’t require referrals.

The referral and notification/prior authorization processes are separate.

Requirements vary by member benefit plan:

  • Use the Eligibility and Benefits (on Link) tool at UHCprovider.com/Link to find out if referrals, notifications or prior authorizations are required for the requested services.
  • Use the referralLink tool on Link to see if a referral is needed for your patient, submit a referral request and check referral status.
  • Referrals to network physicians must be submitted electronically by the member’s PCP or a PCP with the same tax ID number (TIN).

Refer to the member ID card to identify the member’s benefit plan. The ID card will also show if a referral is required. Standard prior authorization and notification requirements, listed in UnitedHealthcare Administrative Guide, apply. For more information about NexusACO referral requirements, go to UHCprovider.com/referrals.

For More Information

If UnitedHealthcare NexusACO is available in your area, you can find more information at UHCprovider.com > Menu > Health Plans by State > choose your state > UnitedHealthcare NexusACO. You can also watch an on-demand video overview of NexusACO online at UHCprovider.com/uhconair to learn more.