Designated Diagnostic Provider (DDP)

Complete Lab Quality Questionnaire by March 10, 2021.

In an effort to reduce member cost and improve transparency, we’ve created, subject to state regulatory approval, Designated Diagnostic Provider benefit designs. For fully insured commercial plan members, outpatient laboratory services will only be covered when delivered by freestanding or hospital lab providers who meet certain quality and efficiency requirements.

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.

Why Designated Diagnostic Providers?

We are continuing our work toward the Triple Aim of better care, better health and lower costs for UnitedHealthcare members. Designated Diagnostic Provider benefit designs are intended to maximize member benefits for lab services and ensure laboratory services are performed by providers that meets both efficiency and quality requirements. 

When you help your patients choose health care services that are high quality with less cost, they are more likely to get needed care and be more engaged in improving, maintaining and managing their health. Together, we can make the health system work better for everyone by consistently promoting cost-effective lab locations that deliver safe, high-quality care.

Provider Requirements

To become a lab Designated Diagnostic Provider and participate in the benefit designs, you need to meet certain quality and efficiency requirements by March 10, 2021. You can verify your lab Designated Diagnostic Provider status by contacting your dedicated network representative.

In support of these new benefit designs, you will work with your dedicated network representative.

How it Works

For Designated Diagnostic Provider benefit designs and subject to state regulatory approval, 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:

  • Complete the Designated Diagnostic Provider lab quality questionnaire by March 10, 2021
  • If you meet the lab quality and efficiency requirements, you will become a Designated Diagnostic Provider for lab services and be notified accordingly
  • If you do not meet the lab Designated Diagnostic Provider requirements for lab services, a dedicated network representative will reach out to follow up and support the process

We will have an icon in our directories that identifies Designated Diagnostic Providers.

To check member eligibility, you can use our Eligibility and Benefits feature directly within your EMR using Point of Care Assist or on Link. Both give you instant access to the latest eligibility and benefits information in real time without needing to pick up the phone. Within Link, you can also check coverage dates, policy information and detailed benefit information, as well as access digital ID cards.

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