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Specialist Tiering for the 2020-2021 Plan Year

For the plan year starting July 1, 2020, UniCare will continue group tiering for Massachusetts specialists.

How Tiering Is Determined

Each practice or group is placed in a tier and all specialists within that practice have the same tier placement. This includes doctors, nurse practitioners, and physician assistants who practice specialty care. However, if a specialist moves to a different practice during the year, their tier may change.

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).

Please note, these tier placements apply only to specialists within any given practice. Primary care providers (PCPs) are not subject to these tier placements.

  • Tier One

  • Tier Two

  • Tier Three

Practices and specialty groups related to hospitals in CHIA’s Community category

Practices and specialty groups not in Tier One or Tier Three (including those related to hospitals in CHIA’s Teaching and Specialty categories)

Practices and specialty groups related to hospitals in CHIA’s Academic Medical Center category

Helpful Resources