The Medical Condition Assessment Incentive Program (MCAIP) aligns with the Medicare Advantage Primary Care Physician Incentive (MA-PCPi) program. MCAIP offers 3 bonus opportunities when you assess suspect medical conditions for your patients.

2024 incentive opportunities

Eligibility

We invite eligible primary care physicians to enroll in the program annually. Your invitation to participate is sent by mail and outlines the current year’s bonus opportunities and criteria.

Opportunity #1: Medical Condition Assessment Incentive Bonus

Your practice can earn a quarterly bonus when you assess eligible UnitedHealthcare® Medicare Advantage members for suspect medical conditions. Eligible members and medical conditions are identified in the Patient Care Opportunity Report (PCOR) and Practice Assist. Practice Assist is also used to document the results of your assessment.

Here’s how it works:

• Earn $20 for each suspect medical condition that you’ve assessed and diagnosed or assessed but were unable to diagnose
• If a suspect medical condition is diagnosed, include the appropriate ICD-10 code(s) when you submit the claim
• If you assess but are unable to diagnose the condition, report in Practice Assist that you’re unable to diagnose the suspect condition at the present time. Be sure to include the date of the assessment.

Opportunity #2: Fully Assessed MCAIP Customer Bonus

Your practice may earn an additional $10 for each suspect medical condition you assess for a fully assessed member. Fully assessed means the member has been assessed for each suspect condition. The bonus is multiplied by the total number of suspect medical conditions that you assessed for the member.

Bonus calculation

Opportunity #3: Medical Condition Assessment Superior Bonus

Earn an additional annual bonus by:

• Achieving an Average Star Rating of at least 4.00 within the MA-PCPi program, and
• Assessing at least 65% of identified suspect medical conditions

Performance level bonus opportunities

Track your progress

You can use Practice Assist to monitor your progress toward these incentive opportunities. It’s available on the UnitedHealthcare Provider Portal in the Clinical & Pharmacy section. To access the portal, click Sign In in the upper right corner of this page, then log in with your One Healthcare ID and password. If you don’t have an ID and password, you can register for one. 

Payout dates

Tips for success

• Prioritize which members should come in for a visit using the Patient Care Opportunity Report (PCOR) or Practice Assist
  • PCOR shows which members are due for preventive care including screenings, annual care visits or other exams. Review the self-paced training for more details and instructions.
• Before the member’s appointment, highlight suspect medical conditions in each patient’s medical record
• If you’re unable to diagnose a suspect medical condition at the care visit, report the information in Practice Assist by checking the box that confirms the condition was assessed but unable to be diagnosed and the date of service

Resources

• Medicare Advantage Primary Care Physician Incentive program 
• Terms and conditions
  

Questions?
Contact your UnitedHealthcare representative if you have questions or need more information.