If you are experiencing connectivity issues with UnitedHealthcare, please use our secure self-service options in the UnitedHealthcare Provider Portal or an existing API connection. The portal is currently available to check eligibility, manage claim reconsiderations and appeals, and submit prior authorization requests.
Reports and Quality Programs
UnitedHealthcare offers a variety of reports and quality programs to help care providers provide operational efficiency and member support. For more information on what is available, click the [+] below.
Capitation, Claim, Quality, Roster and Profile Reports - UnitedHealthcare
Access a variety of reports including capitation, claim, quality, profile / provider rosters with the UnitedHealthcare Reports tool.
Capitation, Settlement, Shared Risk Claims, Eligibility, and Patient Management Reports - UnitedHealthcare West
UnitedHealthcare West providers for SignatureValue and Medicare Advantage HMO plans have access to a variety of reports families including Capitation, Settlement, Shared Risk, Claims, Eligibility and Patient Management reports.
Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Survey and the Health Outcomes Survey (HOS)
The Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey and the Health Outcomes Survey (HOS) help provide feedback on your patient’s experience with you, the provider and us. UnitedHealthcare’s goal is to continue to help improve the overall experience for your patients and our members.
Collaborate. Educate. Evaluate. These core values define the PATH program’s tools and resources, which were designed to help patients live healthier lives. Together, we can work to help make this goal a reality.
Physician Performance Based Compensation - Includes PCOR, PCMH, PCPi and QPIP Reports
UnitedHealthcare is committed to providing physicians with actionable, patient-specific information that will help them deliver the best possible clinical care while empowering them to meet personal and professional goals through our Physician Performance-Based Compensation Program (PPBC).
This program includes the Patient Care Opportunity Reports (PCOR), the Patient-Centered Medical Home Program (PCMH), the Primary Care Physician Incentive Program (PCPi) and Quality Provider Incentive Program (QPIP).
As a UnitedHealthcare network care provider, you have options on where your patients who are our plan members receive their surgical care – in the office, at an ambulatory surgical center, or in an in-patient hospital setting. Like you, we’re always looking for new ways to better achieve positive outcomes, which is one of the reasons we created and are piloting the Quality-Based Physician Incentive Program (QPIP) for care providers in select markets.
With QPIP, you have the opportunity to earn an incentive payment by performing clinically appropriate procedures at designated facilities and meeting certain quality metrics.
The UnitedHealth Premium® program designates physicians based on safe, timely, effective and efficient quality care criteria. This designation may be used by members to help make more informed choices for their medical care and by physicians to make referrals. Physicians may also use evaluation details to support their efforts to provide quality care to their patients.
In markets where tiered benefit plans are available, employers may offer employees a tiered benefit plan with a lower member cost share for using select Premium Care Physicians.