Kentucky Medicaid: What you need to know about the updated primary care attribution process
To help ensure that UnitedHealthcare Community Plan of Kentucky patients are assigned to the primary care provider (PCP) who is most actively involved in their care, we’ve made an update to our attribution process.
Effective March 1, 2025, we’ll perform quarterly 24-month claim look-backs to determine if a member has been regularly engaged with a non-assigned PCP. If you are currently seeing patients who are not assigned to your practice, we may reassign these patients to you. We hope this change will lead to better health outcomes and more efficient care management.
Claim look-back exclusions
Primary care codes received from the following facilities will be excluded from the claim look-back and not considered for member reassignment:
- Comprehensive inpatient rehabilitation facility
- Emergency room hospital
- Inpatient hospital
- Inpatient psychiatric facility
- Pharmacy
- Urgent care
Specialties that may have attribution
The following practitioner specialties may have attribution:
- Adolescent medicine
- Advanced registered nurse practitioner
- Clinical nurse, non-behavioral
- Family nurse practitioner
- Family practice
- Federally Qualified Health Center (FQHC)
- General practice
- Internal medicine
- Internal medicine pediatrics
- Nurse practitioner
- Obstetrics and gynecology (OB-GYN)*
- Pediatrics
- Pediatric nurse practitioner
- Physician’s assistant
- Rural health clinic (RHC)
Questions? We’re here to help
If you have questions, please call Provider Services at 866-633-4449.
*The OB-GYN specialty is included at the member’s assigned PCP tax ID number (TIN); however, patients will not be moved to an OB provider through this attribution process.
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