Medical Condition Assessment Incentive Program
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 submit Assessments of Suspect Medical Conditions for your patients who are UnitedHealthcare® Medicare Advantage members. These patients are also referred to as MCAIP customers.
2025 MCAIP information and dates
If there is a conflict between this page and the Terms and Conditions, the Terms and Conditions control.
2026 incentive opportunities
MCAIP Assessment Bonus
Get rewarded when you submit an Assessment and documentation, in compliance with the MCAIP Terms and Conditions, of 1 or more face-to-face comprehensive exams in 2026 that occur after you receive the member’s Assessment information from Optum.
Fully Assessed Bonus
Earn an additional bonus for each member when you submit an Assessment that has all Suspect Medical Conditions assessed during a care visit within the MCAIP term.
Medical Condition Assessment Superior Bonus
Earn an additional bonus when you achieve 55+ Performance Points in the MA-PCPi program and submit at least 70% of valid Assessments.
Eligibility
Each year, we invite eligible primary care physicians to enroll in the program. You’ll receive an invitation to participate by mail that details the current year’s bonus opportunities and criteria.
Opportunity 1: MCAIP Assessment Bonus
Your practice can earn an MCAIP Assessment Bonus when you submit an Assessment and documentation for eligible members. Your office will receive the members’ Assessment information from Optum.
Here’s how it works:
- We’ll pay you $25 for each Assessment returned within 60 days of the latest date of service submitted
- You’re eligible for $15 for each assessment received 60 days after the latest date of service submitted
- You’ll be eligible for an adjusted MCAIP Assessment Bonus of $15 when the documentation of 1 or more face-to-face comprehensive exams occurs prior to providers receipt of an Assessment
- Submissions received after Jan. 31, 2027, will not be eligible for the MCAIP Assessment Bonus
- Compensation for the Medical Condition Assessment Bonus will be limited to a single returned Assessment per member per year
Opportunity 2: Fully Assessed Bonus
Your practice can earn an additional $150 for a Fully Assessed Bonus for members that have all their Suspect Medical Conditions assessed by you during a care visit within the MCAIP term.
How it works
- You must provide documentation of one or more face-to-face comprehensive exams in 2026.
- You must complete and return all pages of the Assessment and a medical record to support all existing chronic conditions and co-morbid factors, documented to the highest level of specificity.
- Medical records must include: Date of service, provider name, credentials and a valid signature must appear at the end of each documented member visit. The member’s name and date of birth must be present on all pages of the medical record.
- An Assessment must have a documented action for all conditions included in the Assessment to be considered fully assessed. Eligible actions in the Assessment are defined as:
- Assessed and present – Must be documented to the highest degree of specificity in the medical record submitted to Optum
- Assessed and unable to diagnose at this time – You’ve assessed the member for the suspected condition and don’t find evidence of it
- Referred – Member is assessed and referred to another provider for further evaluation and/or management of the condition
Opportunity 3: Medical Condition Assessment Superior Bonus
Earn an additional annual bonus by:
- Achieving 55+ Performance Points within the MA-PCPi program
- Achieving a return rate of at least 70% of Assessments
Payment based on MCAIP Assessment return rate
| Percentage of MCAIP Assessments returned | Medical Condition Assessment Superior Bonus (Per valid Assessment noted in the final reporting) |
|---|---|
| 90%-100% | $200 PMPY |
| 80%-89% | $150 PMPY |
| 70%-79% | $100 PMPY |
| 69% and below | $0 PMPY |
Track your progress
You can use Practice Assist or your Patient Care Opportunity Report (PCOR) to monitor your progress toward these incentive opportunities and use your Key Measure Opportunity Report (KMOR) in Practice Assist to identify which members need care. It’s available in the UnitedHealthcare Provider Portal in the Clinical & Pharmacy dropdown menu. To access the portal, click Sign In in the upper right corner of this page.
Payout dates
| Quarterly bonus opportunities | |
|---|---|
| Dates of service | Payment date |
| Jan. 1–March 31, 2026 | July 31, 2026 |
| April 1–June 30, 2026 | Oct. 31, 2026 |
| July 1–Sept. 30, 2026 | Jan. 31, 2027 |
| Oct. 1–Dec. 31, 2026 | May 31, 2027 |
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, 2026 | May 31, 2027 |
Tips for success
- Prioritize which patients should come in for a visit by accessing your KMOR in Practice Assist or Patient Care Opportunity Report (PCOR)
- Before the patient’s appointment, highlight Suspect Medical Conditions and/or open care opportunities, such as late or missed screenings, in the patient’s assessment information provided by Optum.
- Fill out the applicable Assessment and document actions for all conditions included in the assessment. Submit the Assessment and the necessary compliant medical records to support any existing chronic conditions and co-morbidity factors within 60 days of the latest date of service.
Questions? We’re here to help.
If you have questions, please contact your Provider Performance Team. For chat options and additional contact information, visit our contact resources.