In response to the COVID-19 Public Health Emergency (PHE), UHC has made a decision to delay the implementation of the Laboratory Test Registry Protocol to January 1, 2021. A UHC representative informed XIFIN in a July 17, 2020 correspondence, “To ensure compliance with these requirements, free-standing and outpatient hospital lab providers should register their laboratory tests prior to December 1, 2020." Update to be published shortly.
Starting January 1, 2021 (Previously October 1, 2020, before the recent decision to delay), United Healthcare (UHC) requires in-network, free-standing, and outpatient hospital lab providers’ claims for test services to contain a unique test code for each service. Each test code on a claim must also match a laboratory test registration. UHC is requiring that laboratories register their tests through the UHC Laboratory Test Registry by December 1, 2020. These requirements apply to most UnitedHealthcare Commercial, Medicare Advantage, and UnitedHealthcare Community Plan networks.
The appropriate lab test codes must be included on claims for in-scope laboratory test services. These codes will serve as each laboratory’s unique identifier. Clients, such as a physician, for example, will use these test codes to order each test. Starting January 1st, the test codes will uniquely identify each test for each laboratory.
According to the UHC FAQ, all in-network, freestanding, and outpatient hospital laboratory testing services are required to follow these new requirements with the exception of:
Tests that are part of the UHC Genetic and Molecular Lab Testing Notification/Prior Authorization process:
Tests that are part of the UHC Molecular Pathology Reimbursement policy:
Tests rendered by outpatient physician office laboratories, using a Place of Service 11.
In short, place of service 81 (independent labs) and 22 (outpatient) are included under this protocol if they are in-network with UHC. It is important for XIFIN clients to know that we are able to use an ad hoc report in our business intelligence (BI) system to pull in some of the data requirements to bulk load new test codes. We will use similar logic to the UHC GTR requirements; however, the GTR code will be in a different segment than the Lab code:
UHC Molecular Pathology GTR Code
Submit the GTR unique test ID preceding the decimal in field 2400 SV101-7 on the electronic claim form (or in the shaded area of the service line in section 24 on a paper claim form).
UHC Laboratory Test Registry
- Each time a laboratory CPT code or HCPCS code is populated in SV202-2 Institutional Service Section, the corresponding test code, prefixed with 'LAB,' should be placed in the Loop 2400 Service Line Number (NTE - Notes Section).
- Each time a laboratory CPT code or HCPCS code is populated in SV101-2 Professional Service Section, the corresponding test code, prefixed with 'LAB,' should be placed in the Loop 2400 Service Line Number (NTE - Notes Section).
The new test codes must correspond to what the physician ordered, whether it is a single test billed as a single procedure code or a “panel” that bills as multiple procedure codes. Claims without the proper registry and lab test codes may be denied.
For Quick Reference:
- FAQS — https://www.uhcprovider.com/content/provider/en/viewer.html?file=%2Fcontent%2Fdam%2Fprovider%2Fdocs%2Fpublic%2Fpolicies%2Flab%2FLab-Test-Registry-FAQ.pdf
- Test Registry Reference Guide — https://www.uhcprovider.com/content/provider/en/viewer.html?file=%2Fcontent%2Fdam%2Fprovider%2Fdocs%2Fpublic%2Fpolicies%2Flab%2FQRG-Test-Registry-2020.pdf