Per the UHC Website: “In an effort to reduce member cost and improve transparency, we’ve created, subject to state regulatory approval, Designated Diagnostic Provider benefit designs. For fully insured commercial plan members, outpatient laboratory services will only be covered when delivered by freestanding or hospital lab providers who meet certain quality and efficiency requirements. Designated Diagnostic Providers are designed to support our members in choosing cost-effective and high-value care providers. Effective July 1, 2021, and subject to state regulatory approval, outpatient diagnostic lab services will only be covered for members with UnitedHealthcare Designated Diagnostic Provider benefit designs if delivered by Designated Diagnostic Providers. Services may not be covered and your patients could be responsible for payment if performed by providers who are not designated. UnitedHealthcare will build out access as necessary to help ensure all members and physicians have access to Designated Diagnostic Providers.”
Summary:
- Impacts all UHC in-network pathology and laboratory clients billing for outpatient – hospital-based and independent labs
- Out-patient Diagnostic Lab Services will only be covered by UHC Designated Providers
- Effective Date: July 1, 2021 for commercial claims
- Non-Designated Diagnostic Providers will remain in network, but outpatient diagnostic lab services will deny as non-covered
- Non-participating labs are not eligible to become a Designated Diagnostic Provider
Action Items: Complete the Designated Diagnostic Provider lab quality questionnaire by Feb. 28, 2021. Questionnaire must be completed by the laboratory or pathology practice directly because the questions are related specifically to services provided. Change Healthcare cannot complete questionnaire on behalf of clients.
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