The Medical Condition Assessment Incentive Program (MCAIP) aligns with the Medicare Advantage Primary Care Physician Incentive (MA-PCPi) program. MCAIP offers 3 bonus opportunities when you assess suspect medical conditions for your patients.
2023 incentive opportunities
Medical Condition Assessment Incentive Bonus
Get rewarded when you assess suspect medical conditions for Medicare Advantage members.
Fully Assessed MCAIP Customer Bonus
Earn an additional bonus for each fully assessed member.
Medical Condition Assessment Superior Bonus
Earn an additional bonus when you achieve a 4.00 Average Star Rating and evaluate at least 65% of identified suspect medical conditions.
We invite eligible primary care physicians to enroll in the program annually. Your invitation to participate is sent by mail and outlines the current year’s bonus opportunities and criteria.
Opportunity #1: Medical Condition Assessment Incentive Bonus
Your practice can earn a quarterly bonus when you assess eligible UnitedHealthcare® Medicare Advantage members for suspected medical conditions. Eligible members and medical conditions are identified in the Patient Care Opportunity Report (PCOR) and Practice Assist. Practice Assist is also used to document the results of your assessment.
Earn $20 for each suspect medical condition that you’ve assessed and diagnosed or assessed but were unable to diagnose
If a suspect medical condition is diagnosed, include the appropriate ICD-10 code(s) when you submit the claim
If you assess but are unable to diagnose the condition, report in Practice Assist that you’re unable to diagnose the suspect condition at the present time. Be sure to include the date of the assessment.
Your practice may earn an additional $10 quarterly bonus for each fully assessed member’s suspect medical condition. Fully assessed means the member has been assessed for each suspect condition. The bonus is multiplied by the total number of suspect medical conditions that you assessed for the member during the quarter.
Number of suspect conditions
Assessed and diagnosed
Assessed and unable to diagnose
Fully assessed member (Y/N)?
Fully assessed customer bonus
Opportunity #3: Medical Condition Assessment Superior Bonus
Earn an additional annual bonus by:
Achieving an Average Star Rating of at least 4.00 within the MA-PCPi program, and
Assessing at least 65% of identified suspect medical conditions
Performance level bonus opportunities
Percentage of suspect conditions assessed
Medical condition assessment superior bonus
95% and above
85% - 94%
80% - 84%
75% - 79%
65% - 74%
64% and below
Track your progress
You can use Practice Assist to monitor your progress toward these incentive opportunities. It’s available on the UnitedHealthcare Provider Portal in the Clinical & Pharmacy section. To access the portal, click Sign In in the upper right corner of this page, then log in with your One Healthcare ID and password. If you don’t have an ID and password, you can register for one.
PCOR shows which members are due for preventive care including screenings, annual care visits or other exams. Review the self-paced training for more details and instructions.
Before the member’s appointment, highlight suspect medical conditions in each patient’s medical record
If you’re unable to diagnose a suspect medical condition at the care visit, report the information in Practice Assist by checking the box that confirms the condition was assessed but unable to be diagnosed and the date of service