Membership in the UnitedHealthcare NexusACO benefit plans is continuing to grow. Starting Jan. 1, 2020, even more members will have access to the UnitedHealthcare NexusACO plans.
UnitedHealthcare NexusACO is an accountable care organization (ACO)-focused tiered product. The NexusACO benefit plan designs encourage members to receive their care from the Tier 1 providers for the lowest level of cost sharing. Nationally, ACOs in certain markets have been selected to be included in Tier 1 for the UnitedHealthcare NexusACO benefit plans. In markets where ACOs are not yet featured for UnitedHealthcare NexusACO, Tier 1 is made up of UnitedHealth Premium® Care physicians. Members still have access to our broader network of care providers and facilities, but at a higher level of cost sharing.
Tier 1 care providers will have the Tier 1 graphic by their name in the UnitedHealthcare NexusACO care provider directory at UHCprovider.com > Menu > Find a Care Provider > NexusACO Care Provider Directory.
UnitedHealthcare NexusACO Tier 1 care providers are:
Health Plan Key Features
UnitedHealthcare NexusACO includes two benefit plans – NexusACO R and NexusACO OA – and both require that the member select a primary care physician (PCP).
NexusACO R requires referrals.
NexusACO OA doesn’t require referrals.
The referral and notification/prior authorization processes are separate.
Requirements vary by member benefit plan:
Refer to the member ID card to identify the member’s benefit plan. The ID card will also show if a referral is required. Standard prior authorization and notification requirements, listed in UnitedHealthcare Administrative Guide, apply. For more information about NexusACO referral requirements, go to UHCprovider.com/referrals.
For More Information
If UnitedHealthcare NexusACO is available in your area, you can find more information at UHCprovider.com > Menu > Health Plans by State > choose your state > UnitedHealthcare NexusACO. You can also watch an on-demand video overview of NexusACO online at UHCprovider.com/uhconair to learn more.