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July Update in Bold
In late October, APS sent a white paper indicating United Healthcare (UHC) had received much opposition to its new policy requiring in network laboratories to register all tests offered to referring physicians, with a unique test order code. In that article, APS indicated that the American Hospital Association lead the way in opposing UHC’s policy as it created burdens on providers and contradicts HIPAA standards as a whole, which require use of standardized code sets for describing services. As a recent development, on July 1, 2021, UHC indicated that this program will be delayed until further notice. This includes registration of non-genetic tests and placement of test codes on claims for non-genetic tests. Per UHC, there is no need to register non-genetic tests at this time. Please click here for the applicable UHC provider news update.
This is good news for the lab community, as this policy is unclear in its intent, processes and application.
On January 1, 2021 United Healthcare (UHC) will put into effect its Laboratory Test Registry Protocol. Laboratories will be required to submit the laboratory’s unique test code for each service performed. Each test code submitted on a claim must match a corresponding laboratory test registration provided in advance to UHC. Failure to submit the lab test with the code will result in the claim being denied. The new requirements will apply to most United Healthcare Commercial, Medicare Advantage and United Healthcare Community Plan networks. To ensure compliance with the new requirements, UHC is asking for free standing and outpatient hospital laboratory providers to register their laboratory tests prior to December 1, 2020.
United Healthcare has stated that simply registering your laboratory services and placing test codes on laboratory claims doesn’t guarantee UHC will pay the claim. Payment for the covered services is based on the member’s eligibility on the date of the service, claim processing requirements and the terms of your Participation Agreement.
As always, APS will continue to monitor this topic closely and provide updates when they become available.