BILLING NEWS

UHC - Designated Diagnostic Provider

“Designated Diagnostic Providers are designed to support our members in choosing cost-effective and high-value care providers. Effective July 1, 2021, and subject to state regulatory approval, outpatient diagnostic lab services will only be covered for members with UnitedHealthcare Designated Diagnostic Provider benefit designs if delivered by Designated Diagnostic Providers. Services may not be covered and your patients could be responsible for payment if performed by providers who are not designated. UnitedHealthcare will build out access as necessary to help ensure all members and physicians have access to Designated Diagnostic Providers.

Non-Designated Diagnostic Providers will remain in network with UnitedHealthcare, but outpatient diagnostic lab services will deny as non-covered for members with Designated Diagnostic Provider benefit designs and your patients may be liable for charges. The Designated Diagnostic Provider benefit designs will not apply to lab services rendered as part of inpatient admissions, emergency room visits or outpatient surgery pre-operation testing that is billed as part of a global surgical package.

In 2022, we will expand these Designated Diagnostic Provider benefit designs to Major Radiology services (MR, CT, PET/Nuclear Medicine). If you are a provider that performs these services, we will communicate to you when it is time to begin the application process to become a Designated Diagnostic Provider for Major Radiology services.”


INDUSTRY NEWS TAGS: Payor


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