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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

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