Download Relative Costs of Network Providers Tool Quick Reference Guide

Relative Costs of Network Providers Tool
Quick Reference Guide
What is the Relative Costs of Network Providers Tool?
UnitedHealthcare’s Relative Costs of Network Providers Tool helps primary care providers (PCPs) make
informed referral decisions for their patients who are our members. Using this tool, you can search
common services or treatments and view the relative costs of care providers for that service. When
applicable, you can also view whether or not the care provider is a Premium Care Physician who has been
identified for quality and cost efficiency.
How it Works
This tool compares care providers’ and facilities’ relative costs for specific services, by market. It also
shows you whether or not a care provider is a Premium Care Physician, so you can consider quality as
well as relative costs when making your referral decisions.
Follow these steps to start using the tool:
• Go into the tool by visiting UnitedHealthcareOnline.com > Clinician Resources > Performance
Measurement and Reporting > Relative Costs of Network Providers Tool
• Enter the applicable ZIP code
• Choose the specialty service required for the UnitedHealthcare member
What it Shows
This tool includes many common services including office visits, preventive visits, and select outpatient,
inpatient, laboratory and radiology services and procedures.
When you run a search, the tool provides the following:
• A list of network care providers in the specified ZIP code who perform the service
• An indication of whether or not the care provider is a Premium Care Physician, for applicable
physician specialties
• A cost banding display to show you if the provider falls into the Below Average, Meets Average
or Above Average range
The tool does not display specific contracted fees and rates, or specific cost estimates for a care provider,
rather, it displays where the provider falls on a spectrum of low-to-high costs relative to other providers
who perform that service in the market area.
Methodology
We use the most commonly found procedure or diagnostic code in our historic claims data to come up
with relative costs for services and procedures.
Cost Bands
We compare the estimated costs of one care provider to that of other care providers in the local area, and
sort the care provider’s costs into one of the following levels:
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•
Below Average - the care provider’s estimate is in the lowest 25% in the local area
•
Meets Average - the care provider’s estimate is in the middle 50% in the local area
•
Above Average - the care provider’s estimate is in the highest 25% in the local area
•
If cost banding is not displayed, a cost estimate was not available for that specific service
from the care provider.
Cost banding is an estimate rather than a guarantee of a care provider’s specific cost. Certain geographic
areas may not be available in this tool at this time.
The cost banding included in this tool represents cost estimates for services under UnitedHealthcare
Choice Plus commercial benefit plans and may not be representative of other UnitedHealthcare benefit
plans. The information is updated quarterly.
Provider-specific cost data used to develop the cost banding is based on current contracted fees for a
provider, and if current contracted fees or rates are not available, historical claim average (median
allowable) costs may be utilized.
For more information, contact your Network Representative.
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