To comply with state and federal data collection and reporting requirements, we require clinical data from you. It helps us measure quality of care for our members. It helps us collaborate with you to address gaps in care. You must submit all clinical data including laboratory test results. Give us this data within 30 calendar days from the date of service or within the time specified by law.
When giving us clinical data, you must follow state and federal laws, and obtain prior consent to give us the clinical data when state or federal law requires it. We need to provide the source of the data to satisfy National Committee for Quality Assurance (NCQA) audits or other compliance requirements. You must confirm that the information given to us is accurate and complete.
We verify that security measures, protocols, and practices are compliant with:
We use the clinical data to:
We will work collaboratively with you to help ensure all clinical data values are being transmitted effectively. This allows for lawful identification and use of the clinical data.
We define the HIPAA minimum necessary data requirements defined in specific documents related to the method of clinical data acquisition. The companion guides that contain these requirements are on UHCprovider.com/edi.
This protocol applies to all participating physicians and health care professionals, and it applies to all laboratory services, clinical and anatomic, ordered by physicians and health care professionals.
We do not allow our health care providers to earn money from referring members to a lab. This includes profits from:
If you do not follow this rule, we may:
Our protocols require electronic submission of lab results within 30 days of a lab test. This supports HEDIS closure rates and significantly reduces the burden of manual chart requests for our care providers.
Care providers are required to submit an expanded set of clinical data following a physician visit, as well as a discharge summary within seven days of an inpatient discharge. Failure to comply with this clinical data exchange may result in penalties to your practice.
When you share this data with us electronically, we can:
To begin sharing the required information, visit UHCprovider.com/ediconnect to find the best solution for your practice. Care providers have different data transfer capabilities, and we will work with you to find the best method of data transmission.