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Laboratory Benefit Management Program

The UnitedHealthcare Lab Benefit Management program is the first health plan to integrate evidence-based guidelines directly into the lab ordering process. This can help improve the quality of outpatient laboratory services, support evidence-based guidelines for patient care and lower costs for our members.

Reminder: Network physician offices and laboratories are asked to include test identifiers on claims. A test identifier is an internal laboratory code used to more accurately identify a specific test performed by a laboratory.

Program Update: We've identified certain physician office-based tests billed with place of service (POS) 11 that can be accurately identified using CPT codes alone.

  • Claims for the identified CPT codes billed with POS 11 will not be impacted if a test identifier is not included on the claim.
  • Please see the Test Identifier Exclusions guide to view these CPT codes.
  • Previously submitted claims for these CPT codes that resulted in claims impact for lack of a test identifier are being reprocessed.

Helpful Resources

Scope

All outpatient laboratory services for members who are part of the Laboratory Benefit Management Program are subject to requirements including advance notification and medical policies. To avoid claim and service impacts, please make sure your practice or laboratory is following Laboratory Benefit Management Program requirements as described in the Administrative Protocol.

The Laboratory Benefit Management Program is now optionally available to providers in Texas.

  • The Physician Decision Support tool can help you become familiar with the process and to enhance coordination when ordering tests. We're also eager for your feedback on the tool.
  • Physician Decision Support is available today.
  • We'll notify you 90 days in advance of initiating denials for impacted claims.

Getting Started

Beacon Laboratory Benefit Solutions, Inc. (BeaconLBS®), a subsidiary of LabCorp®, administers the Laboratory Benefit Management Program for UnitedHealthcare. If you're not yet registered with BeaconLBS, please visit BeaconLBS.com and select Login|Register. 

Helpful Resources

Labs-of-choice™

Labs-of-choice™ is a network of preferred laboratories identified by Beacon Benefit Solutions (BeaconLBS®), which specializes in laboratory service management. They can help reduce overutilization of laboratory test orders and direct members to qualified in-network laboratories

Labs-of-choice™  

The Laboratory Benefit Management Medical Policies provide assistance in interpreting UnitedHealthcare benefit plans. (to 4a)

These Clinical Guidelines apply to the UnitedHealthcare Laboratory Benefit Management Program. (to 4b)

This Reimbursement Policy applies to the UnitedHealthcare Laboratory Benefit Management Program. Click to find additional information about UnitedHealthcare Reimbursement Policies

Learn more about the Laboratory Benefit Management Program.

Questions?

If you have questions about the program, please contact your network manager or Provider Advocate.

Training

To schedule a webinar training session for your practice or group, please email lab_ben_mgmt@uhc.com.