Medical Condition Assessment Incentive Program
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 who are UnitedHealthcare® Medicare Advantage members. These patients are also referred to as MCAIP Customers.
2024 MCAIP information and dates
If there is a conflict between this page and the Terms and Conditions, the Terms and Conditions control.
2025 incentive opportunities
MCAIP Bonus
Get rewarded when you assess Suspect Medical Conditions for Medicare Advantage members.
Fully Assessed MCAIP Customer Bonus
Earn an additional bonus for each fully assessed member.
Medical Condition Assessment Superior Bonus
Earn an additional bonus when you achieve 60+ Performance Points in the MA-PCPi program and evaluate at least 65% of identified Suspect Medical Conditions.
Eligibility
Each year, we invite eligible primary care physicians to enroll in the program. You’ll receive an invitation to participate by mail that details the current year’s bonus opportunities and criteria.
Your practice can earn a quarterly bonus when you assess eligible Medicare Advantage members for Suspect Medical Conditions. Eligible patients and Suspect 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 documented 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’re unable to diagnose the condition, report in Practice Assist that you’re unable to diagnose the Suspect Medical Condition at the present time. Be sure to include the date of the assessment.
Your practice can earn an additional $10 quarterly bonus for each fully assessed Suspect Medical Condition. Fully assessed means the patient has been assessed for each Suspect Medical Condition. The bonus is multiplied by the total number of Suspect Medical Conditions that you assessed for the patient during the quarter.
Example
| Patient | Number of Suspect Medical Conditions | Assessed and diagnosed | Assessed and unable to diagnose | Not assessed | Fully assessed? | Fully Assessed MCAIP Customer Bonus |
|---|---|---|---|---|---|---|
| Suzy Member | 7 | 5 | 1 | 1 | N | 0 |
| Joe Example | 8 | 7 | 1 | 0 | Y | $80 |
| Alisha Patient | 10 | 8 | 2 | 0 | Y | $100 |
| Total | 25 | 20 | 4 | 1 | – | $180 |
Not based on actual members or their information. The names used are fictitious.
Earn an additional annual bonus by:
- Achieving 60+ Performance Points within the MA-PCPi program, and
- Assessing at least 65% of identified Suspect Medical Conditions
Opportunities at each performance level
| Percentage of Suspect Medical Conditions assessed | Medical Condition Assessment Superior Bonus |
|---|---|
| 95% and above | $125.00 per member per year (PMPY) |
| 85%–94% | $100.00 PMPY |
| 80%–84% | $75.00 PMPY |
| 75%–79% | $50.00 PMPY |
| 65%–74% | $25.00 PMPY |
| 64% and below | N/A |
Track your progress
You can use Practice Assist to monitor your progress toward these incentive opportunities. It’s available in the UnitedHealthcare Provider Portal in the Clinical & Pharmacy dropdown menu. To access the portal, click Sign In in the upper right corner of this page.
Payout dates
| Quarterly bonus opportunities | |
|---|---|
| Dates of service | Payment date |
| Jan. 1–March 31, 2025 | July 31, 2025 |
| April 1–June 30, 2025 | Oct. 31, 2025 |
| July 1–Sept. 30, 2025 | Jan. 31, 2026 |
| Oct. 1–Dec. 31, 2025 | May 31, 2026 |
To help ensure the provider is reimbursed as outlined, UnitedHealthcare will review the provider’s claims and data submissions for the previous quarter(s) and make additional payments, if applicable. |
|
| Annual bonus opportunity | |
|---|---|
| Dates of service | Payment date |
| Jan. 1–Dec. 31, 2025 | May 31, 2026 |
- Prioritize which patients should come in for a visit by accessing your PCOR or Practice Assist
- PCOR shows which of your patients are due for preventive care, including screenings, annual care visits or other exams
- Before the patient’s appointment, highlight Suspect Medical Conditions in their medical record
- If you’re unable to diagnose a Suspect Medical Condition at the time of the care visit, report this information in Practice Assist. Add a note that indicates the date of service and confirms you assessed the patient.
Questions?
If you have questions, please contact your UnitedHealthcare representative or practice performance manager. For additional support, visit our Contact us page.