Laboratory Benefit Management Program Claims Impact Begins April 15, 2015 in Florida

UnitedHealthcare will implement the Laboratory Benefit Management Program effective April 15, 2015. The Laboratory Benefit Management Program was developed to help manage appropriate utilization for outpatient laboratory services. The pilot program is limited to fully insured Commercial members in Florida, excluding Neighborhood Health Partnership members. As part of the Laboratory Benefit Management Program, all outpatient laboratory services for these members will be subject to new requirements including advance notification and new medical policies.  If advance notification is not on file, the rendering laboratory should contact the ordering physician to complete the notification process. Advance notification must be completed within 10 calendar days from the date of service.

If there is no advance notification on file and the services are performed in place of service (POS) 11 or 81, the claim will deny as provider liability. Network providers cannot balance bill the member for covered services.

Source: https://www.unitedhealthcareonline.com