Non-Patient Lab Reimbursement Limitation
February 10, 2020Changes are being made on May 1, 2020, to UnitedHealthcare’s non-patient lab reimbursement requirements.
Hospital Reference Lab Protocol: For claims paid on or after May 1, 2020, hospitals acting as a Reference Laboratory or conducting diagnostic testing for non-patients cannot bill for such non-patient diagnostic laboratory tests under that hospital’s Facility Participation Agreement. Hospitals wishing to participate in UnitedHealthcare‘s commercial network as a Reference Laboratory may apply with UnitedHealthcare to be credentialed and contracted as a Reference Laboratory.
Definitions:
- Reference Laboratory: A laboratory that performs diagnostic testing on specimens it receives from other referring laboratories or care providers.Non-patient: Is a member that is neither an inpatient nor an outpatient of a hospital, but for whom a specimen is submitted for laboratory testing to a hospital.
- What Hospitals Need to Do To contract your hospital as a Reference Laboratory, please contact your network representative to begin the credentialing and contracting process.
Claims submitted for non-patient diagnostic laboratory tests, or claims where a hospital is acting as a Reference Laboratory, will be denied for failure to comply with this protocol in the event a hospital is billing under its Facility Participation Agreement.