UnitedHealthcare has created, subject to state regulatory approval, Designated Diagnostic Provider benefit designs to reduce member cost and improve access to quality care.
Coverage at the highest tier
As we continue our work toward the Triple Aim of improving health outcomes, reducing costs and providing a better experience for UnitedHealthcare members, we integrated the standards of quality care established by accredited organizations for imaging services. Including these standards of care into our Designated Diagnostic Provider benefit design is an important step to improving the member experience and making health care more affordable by addressing the high cost of certain services that can be performed at a lower cost by different providers.
Under the benefit design, major imaging services, which include MRI, CT, PET scan, MRA, and nuclear medicine, must be performed by a Designated Diagnostic Provider in order for the member to have the lowest out-of-pocket cost. The new benefit design will protect our members from higher imaging costs by providing access to imaging facilities that meet broadly recognized quality and efficiency standards. Benefits will be available for major imaging services received from a non-Designated Diagnostic Provider, but it will be covered with higher member cost share. Benefits will still be available when received from a non-Designated Diagnostic Provider, and those providers will remain in-network, but members will have higher out-of-pocket costs.
2 steps to becoming an Imaging Designated Diagnostic Provider: Meet Quality standards and Efficiency requirements
UnitedHealthcare will review your questionnaire and reach out to you about efficiency requirements. If you meet the UnitedHealthcare imaging quality and efficiency requirements, you’ll be notified that you are a Designated Diagnostic Provider for imaging services.
If you do not meet the Designated Diagnostic Provider requirements for imaging services, a network representative will follow up with you to discuss what quality and efficiency measures need to be improved before you can qualify for the program.
An icon identifying you as a Designated Diagnostic Provider for imaging will be added to our provider and member directories. Referring providers will be able to identify Designated Diagnostic Providers for imaging directly through their electronic medical records (EMR) with Point of Care Assist® or by signing in to the UnitedHealthcare Provider Portal with their One Healthcare ID.
Benefit design availability
Beginning Jan. 1, 2022, where approved, UnitedHealthcare fully insured small group commercial plan members will have the Designated Diagnostic Provider benefit designs for major imaging services as part of their health benefits. Large group commercial members will have the Designated Diagnostic Provider benefit beginning July 1, 2022. The Designated Diagnostic Provider benefit goes into effect beginning July 1, 2022.
Members with this benefit will pay a lower cost share when they receive services from Designated Diagnostic Provider facilities, which are free-standing major imaging service facilities or outpatient hospital facilities that have met certain quality and efficiency standards. Members will have to pay a higher cost share when they receive services from a facility that is not a Designated Diagnostic Provider.