Update
In February 2020, APS published the below white paper on United Healthcare’s (UHC) new registry requirement for hospitals and free-standing labs. Since then, UHC originally changed the deadline to apply from February 28th to March 10th, but later removed the deadline from their website altogether. There has been no explanation to date as to why this change has been made, but APS will continue to monitor the situation and provide more updates as they arise.
Notably, the questionnaire to apply is still available and the effective date remains July 1, 2021. This requirement applies to providers who perform and bill clinical lab tests on ancillary or lab agreements, but it does not affect those who bill under a medical group agreement. To check member eligibility, providers can use the Eligibility and Benefits feature within their EMR using Point of Care Assist or on Link. They can also verify their Designated Diagnostic Provider (DDP) status by contacting their dedicated network representative. For more thorough information, please see below.
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New United Healthcare Registry Requirement for Hospital and Free-Standing Labs
February 2020
Overview
United Healthcare (UHC) has recently notified providers that they will be implementing a new program, pending state regulatory approval, aimed at enhancing transparency and reducing member costs for out-of-network (OON) services. This program requires providers to complete a questionnaire by February 28th, 2021 to be certified as Designated Diagnostic Providers and will take effect July 1st, 2021. At that point, services will only be covered for Designated Diagnostic Providers, and patients could be responsible for payments if outpatient services are provided by diagnostic labs that are not designated. This UHC program is one of a few that have been rolled out recently that continue to regulate pathology and laboratory services.
Notably, the College of American Pathologists (CAP) has concerns with this new program and, as such, has scheduled a meeting with UHC to better understand the program and advocate for pathologists and laboratories across all settings. The CAP will continue to protect patient access to pathology services and ensure pathologists can practice without undue difficulties or interference. Updates will be provided as new information comes to light.
Highlights
- The Designated Diagnostic Provider program impacts UHC in-network pathology and laboratory clients billing for outpatient—hospital-based and independent labs
- Outpatient diagnostic lab services will only by covered for UHC Designated Providers
- Non-Designated Diagnostic Providers will continue being in-network, but outpatient diagnostic lab services will be denied as not covered
- Labs that are out-of-network are not eligible to become a Designated Diagnostic Provider
Important Dates
Feb. 28th – Providers must complete the DDP Questionnaire.
July 1st – DDP program goes into effect.
Final Thoughts
Importantly, the Designated Diagnostic Provider program only applies to hospitals and free-standing labs that are under facility or ancillary agreements. Those who exist under a professional agreement would be outside the purview of this program. Additionally, those labs or pathology practices who complete the questionnaire must do so directly.
As this program goes into effect, UHC intends to take the necessary actions to ensure all members and physicians have access to Designated Diagnostic Providers. The benefit designs of this program will not apply to inpatient admissions lab services, emergency room visits, or outpatient surgery pre-operation testing which is billed as part of a global surgical package. If you do not meet the lab DDP requirements or require support, a dedicated network representative will be made available to you. To check member eligibility, providers can use UHC’s Eligibility and Benefits feature directly within their EMR using Point of Care Assist.
In 2022, UHC plans to expand the Designated Diagnostic Provider benefit designs to Major Radiology services (MR, CT, PET/Nuclear Medicine). If you provide these services, UHC will notify you when the application process to become certified begins.
APS will continue to monitor the progress of this program and its implementation. Additionally, our credentialing team is validating clients this program applies to and will assist in the process of applying if necessary.
Additional Resources
