New Benefit Designs for Outpatient Lab Services: Action Needed

Last modified: January 19, 2021

Effective July 1, 2021, and subject to state regulatory approval, UnitedHealthcare is launching Designated Diagnostic Provider benefit designs to promote a high standard of care and help maximize member benefits for outpatient laboratory services.

For fully insured commercial plan members, outpatient lab services will only be covered when delivered by freestanding or hospital lab providers who meet certain quality and efficiency requirements. We are continuing our work toward the Triple Aim of better experience, better health outcomes and lower costs for UnitedHealthcare members. 

How it Works

Subject to state regulatory approval, Designated Diagnostic Provider benefit designs for outpatient diagnostic lab services will only be covered for members when 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. To participate, you must meet certain quality and efficiency requirements as follows:

Next steps

  • Complete the Designated Diagnostic Provider quality questionnaire by Feb. 28, 2021
  • If you meet the quality and efficiency requirements, you will become a Designated Diagnostic Provider and be notified accordingly
  • If you do not meet the Designated Diagnostic Provider requirements, a dedicated network representative will reach out to follow up and support the process

Become a Designated Diagnostic Provider

Designated Diagnostic Provider benefit designs are intended to maximize member benefits for lab services and ensure that laboratory services are performed by providers that have met both efficiency and quality requirements. Together, we can make the health care system work better for everyone by consistently promoting cost-effective lab locations that deliver safe, high-quality care.

Get Started

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