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Specialist Tiering for Plan Year Starting July 1, 2019


Changes to specialist tiering

For the plan year starting July 1, 2019, UniCare will be moving from individual to group tiering for Massachusetts specialists. We are making this change in response to feedback from both physician groups and members to facilitate the administration of copays within practices, and to align our approach to tiering with the approaches used by other GIC health plans to tier specialists.

How the tier for each practice or group will be determined

Each practice or group will be placed in a tier and all specialists within that practice will have the same tier placement. The determination of the practice or group placement is based upon the group’s contractual and/or evident relationship with a hospital. To determine the tier placement for group practices, we are using the hospital’s designation provided by the Massachusetts Center for Health Information and Analysis (CHIA).

Note: These tier placements apply only to specialists within any given practice. Primary care providers (PCPs) will not be subject to these tier placements.

The tiers are shown in the following table:

Tier 1 Practices and specialty groups related to hospitals in CHIA’s Community category
Tier 2 Practices and specialty groups not in Tier 1 or Tier 3 (including those related to hospitals in CHIA’s Teaching and Specialty categories)
Tier 3 Practices and specialty groups related to hospitals in CHIA’s Academic Medical Center category

Check our Frequently Asked Questions to learn more about specialist tiering effective July 1, 2019.

Check your tier designation starting July 1, 2019 in our Specialist Tier Listing for 2019-2020.

Copays for specialty office visits effective July 1, 2019. (Note: The only copay change will be the reduction of the Tier 3 copay for Basic members from $75 to $60.)

Our hospital listing identifies all Massachusetts hospitals and their tiers.

Find out what UniCare is telling its GIC members about specialist tiering.

Questions?

See tiering information for current plan year ending June 30, 2019.


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