Know more about NexusACO plans

NexusACO® continues to expand around the country, and more UnitedHealthcare members will have access to these plans. We’ve provided a variety of information to help you understand the benefits and features of these plans so you can best support your patients.

Tiered benefits

UnitedHealthcare NexusACO is a commercial tiered benefit plan designed to encourage members to seek care from Tier 1 health care professionals. Tier 1 includes featured Accountable Care Organizations (ACOs) in selected geographic areas and Tier 1 UnitedHealth Premium® Care Physicians in areas around the country where an ACO is not featured.

Because members may have a higher level of benefits when they see Tier 1 providers, we encourage primary care providers (PCPs) to refer members to Tier 1 providers. Tier 1 providers are identified in the UnitedHealthcare Provider Directory with the Tier 1 symbol.

NexusACO features

There are 2 types of NexusACO benefit plans:

NexusACO R plans require referrals
NexusACO OA plans do not require referrals

For both NexusACO plans:

Members must choose a primary care provider (PCP) to manage their overall care
Members may have lower copays and /or co-insurance for services rendered by Tier 1 providers
Standard prior authorization and notification requirements apply
Referrals should be submitted using the referrals tool in the UnitedHealthcare Provider Portal