| As a UnitedHealthcare contracted physician, if you did not receive the UnitedHealth Premium® program designation, you may request to have your designation status reconsidered. While we will review your reconsideration request and the information you submit, we will not alter the program methodology.
Please note that individual physician designation status will be reconsidered for the following reasons only:
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Evidence of incomplete claims data: You demonstrate that your submitted claims data does not accurately represent the care you provided to a UnitedHealthcare member.
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Evidence of data inconsistencies: You demonstrate that inconsistencies exist in the patient detail which impacts the analysis for designation.
Reconsideration will not be granted based on:
All requests for reconsideration must include your rationale for reconsideration and are required to submit the following documents:
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Physician completed Reconsideration Documentation Form, which provides additional supporting information for the non-compliant evidence-medicine-based guidelines and medical rationale.
OR
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UnitedHealth Premium designation Patient Level Detail Report, which provides additional supporting information for the non-compliant evidence-medicine-based guidelines and medical rationale.
Please do not submit lab test detail or copies of patient records. All relevant information should be submitted via the patient detail report. UnitedHealthcare will request copies of these documents from you as needed.
Please submit your request via writing, fax or email along with the appropriate information listed above to:
Email: unitedpremium@uhc.com
Fax: 414-721-0770
Mail: UnitedHealthcare
Inquiry and Reconsideration
Mail Stop: MN012-S117
5901 Lincoln Drive
Edina, MN 55436
We will review your request and supporting documentation, and you will be notified in writing regarding the final designation decision within 30 days.
If you have additional questions, please call us toll-free 1-866-270-5588.
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