Premium Program Methodology
Premium Program 2020 Updates
In July 2020, the Premium program will notify physicians and groups when the updated physician designation details are available. In September 2020, members and consumers will see the updated designations in our care provider directories.
- Go to UnitedHealthPremium.UHC.com to see the Version 13 methodology.
- Click here for an overview of methodology changes for this release.
For this release, the Premium program uses claims submitted and processed for dates of service prior to the President’s proclamation declaring the COVID-19 national public health emergency.
If your practice is affected by COVID-19, visit UHCprovider.com/covid19 for the latest UnitedHealthcare resources.
When you receive your evaluation notification, sign in to UnitedHealthPremium.UHC.com to view Version 13 designation details for physicians or groups in the Premium program. The UnitedHealth Premium program provides physician designations based on quality and cost-efficiency criteria to help members make more informed choices about their medical care.
Physicians may also use these designations when referring patients to other physicians. In markets where tiered benefit plans are available, employers may choose to offer their employees a tiered benefit plan with a lower member cost share for using Premium Care Physicians.
Learn More About the Premium Program
Please see Premium Program News on UnitedHealthPremium.UHC.com
The UnitedHealth Premium reconsideration process allows physicians to request a correction or change to certain quality and/or cost-efficiency information included in their Premium evaluation. If the COVID-19 national public health emergency has affected the amount of time you need to review and request reconsideration of your results, please contact us for an extension to your reconsideration due date.
For more information on requesting reconsideration, please click here.
The Premium program consists of both quality and cost-efficiency evaluations. Quality is the primary program measurement and is assessed using national standardized measures. Cost efficiency is evaluated using two measurements: patient total cost and patient episode cost. The physician’s Premium specialty determines which measurement is applied.
The program evaluates physicians annually using updated quality and cost-efficiency methodologies and data. Physicians receive their designations based on a comparison of current version and previous version evaluation results.