Effective January 1, 2022, United Healthcare (UHC) rolled out their Designated Diagnostic Provider (DDP) program for major imaging services (in approved states) for their fully insured small group commercial plan members. UHC plans to roll the program out to their large group commercial members beginning July 1, 2022.
According to the program, members receiving services at DDP approved free-standing imaging service facilities or outpatient hospitals that perform higher level imaging procedures (MR, CT, PET and Nuclear Medicine) will have lower cost-sharing rates. These facilities must apply and must meet required criteria and efficiency standards to be a Designated Diagnostic Provider. Services performed by a non-DDP provider (whether in or out-of-network) will result in higher cost sharing for the patient, based on the lower fee schedules at DDP locations. UHC argues that using a DDP facility helps ensure high quality care at a lower out of pocket cost.
United Healthcare has rolled out the DDP program in approximately 25 states, and will continue to expand to additional states as approved. Please click here for the most recently updated map.
Highlights on this topic
• The Designated Diagnostic Provider program impacts higher level imaging facilities and outpatient hospitals that are in-network and billing for higher level outpatient imaging services such as CT, MR, PET and Nuclear Medicine. These DDPs will be required to meet standards set by UHC, and will be subjected to a lower fee schedule, thus reducing the patient’s cost-sharing.
• Non-Designated Diagnostic Providers will continue being in-network, but patients will have higher cost sharing at non-DDPs.
• Following the prior authorization process, members and ordering providers will be notified if a non-Designated Diagnostic Provider facility is selected. The UHC representative will then help the provider and patient choose a DDP facility. Additional targeted messaging to members will occur. These in network facilities will be required to meet quality and efficiency standards, and have lower fee schedules.
• Out of network facilities are not eligible to become a Designated Diagnostic Provider.
APS will continue to monitor the progress of this program and its implementation.