For the plan year starting July 1, 2021, 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.
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
- Check our FAQs for Group Tiering for Specialty Care Physicians, effective July 1, 2021, to learn more about specialist tiering.
- Find out your tier designation with our Find Care tool.
- Review Specialty Copays for Office Visits, effective July 1, 2021. (Note: There will be no changes to these copays for the 2021-2022 plan year.)
- Our Acute Care Medical Hospitals in Massachusetts lists all Massachusetts hospitals and their tiers.
- Find out what FAQs about Tiering for Specialty Care Providers UniCare has answered for our GIC members.
- Questions? Email us at UniCareProviderRelations@anthem.com.