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Specialist Tiering for 2020-2021 Plan Year
For the plan year starting July 1, 2020, UniCare will continue group tiering for Massachusetts specialists. This means that all specialists within a practice will have the same tier. This includes doctors, nurse practitioners and physician assistants who practice specialty care. However, if a specialist moves to a different practice during the year, his or her tier may change.
How the tier for each practice or group is determined
Each practice or group is placed in a tier and all specialists within that practice 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 use 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) are not 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, 2020
Check your tier designation in our Find a doctor tool.
Copays for specialty office visits effective July 1, 2020. (Note: There will be no changes to these copays for the 2020-2021 plan year.)
Our hospital listing identifies all Massachusetts hospitals and their tiers.
Find out what UniCare is telling its GIC members about specialist tiering.
Questions?
- See our Frequently Asked Questions.
- Email us at UniCareProviderRelations@anthem.com