Preferred Lab Tiering Benefits on Eligibility and Benefit 270/271 EDI Transactions

UnitedHealthcare Network Bulletin November 2019

Preferred Lab tiering benefits allow members to receive a lower-cost share when services are delivered by a

Preferred Lab Network. It’s important that care providers understand how to recognize these benefits on their

Electronic Data Interchange (EDI) 271 responses.

Message Segment

When a member has the Preferred Lab tiering benefit on their medical plan, it will be indicated in the message segment:

MSG*PLAN INCLUDES PREFERRED LAB BENEFITS~

If you’re a Preferred Lab Network provider and the member’s plan includes the Preferred Lab tiering benefit,

the following message will display:

MSG*PROVIDER IS PREFERRED LAB FOR MEMBER~

Service Type Code 5

STC 5 for diagnostic lab will denote the cost-share for the Preferred Lab tiering benefit. If the member has the

Preferred Lab tiering benefit on their plan, the copay or coinsurance amount will display:

EB*A*IND*5***27**0*****Y~MSG*HIGHEST BENEFIT PREFERRED LAB~

Source: https://www.uhcprovider.com/content/provider/en/viewer.html?file=/content/dam/provider/docs/public/resources/news/2019/network-bulletin/November-2019-Network-Bulletin.pdf