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.
Get rewarded when you assess suspect medical conditions for Medicare Advantage members.
Earn an additional bonus for each fully assessed member.
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.
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.
Here’s how it works:
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.
|Member||Number of suspect conditions||Assessed and diagnosed||Assessed and unable to diagnose||Not assessed||Fully assessed member (Y/N)?||Fully assessed customer bonus|
Earn an additional annual bonus by:
Performance level bonus opportunities
|Percentage of suspect conditions assessed||Medical condition assessment superior bonus|
|95% and above||$125.00 PMPY|
|85% - 94%||$100.00 PMPY|
|80% - 84%||$75.00 PMPY|
|75% - 79%||$50.00 PMPY|
|65% - 74%||$25.00 PMPY|
|64% and below||0|
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.
|Quarterly bonus opportunities|
|Dates of service||Payment dates|
|Jan. 1 – March 31||July 31, 2023|
|April 1 – June 30||Oct. 31, 2023|
|July 1 – Sept. 30||Jan. 31, 2024|
|Oct. 1 – Dec. 31||May 31, 2024|
|To help ensure the provider is reimbursed as outlined, UnitedHealthcare will review the provider's claims and data submissions for the previous quarter(s) and make additional payments, if applicable.|
|Annual bonus opportunity|
|Dates of service||Payment date|
|Jan. 1 – Dec. 31, 2023||May 31, 2024|
Tips for success
Contact your UnitedHealthcare representative if you have questions or need more information.