Kentucky Medicaid: Updates to Primary Care Attribution You Should Know
Kentucky Medicaid: Updates to Primary Care Attribution You Should Know
To ensure UnitedHealthcare Community Plan of Kentucky members are assigned to the primary care provider (PCP) most involved in their care, UnitedHealthcare has updated its attribution process.
Starting March 1, 2025, UnitedHealthcare will conduct quarterly reviews of claims from the past 24 months to check if a member is regularly seeing a non-assigned PCP. If a provider is treating patients not currently assigned to their practice, UnitedHealthcare may reassign those patients to that provider. This change aims to improve health outcomes and streamline care management.
Claim Look-Back Exclusions
Claims for primary care services from the following facilities will not be included in the 24-month claim look-back and will not be considered for member reassignment:
- Comprehensive inpatient rehabilitation facility
- Emergency room hospital
- Inpatient hospital
- Inpatient psychiatric facility
- Pharmacy
- Urgent care
Specialties Eligible for Attribution
The following practitioner specialties may be eligible for member 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?
For any questions, providers should contact Provider Services at 866-633-4449.
