UnitedHealthcare is launching a new benefit design for outpatient diagnostic lab services to help drive patient transparency and manage the cost of healthcare. Outpatient diagnostic lab services will be covered for commercial members at the lowest cost shared when delivered by a Designated Diagnostic Provider.
Designated Diagnostic Providers are designed to support our members in choosing cost-effective and high-value care providers. In select state markets, and subject to state regulatory approval, outpatient diagnostic lab services will be paid at the higher tier for members with UnitedHealthcare Designated Diagnostic Provider benefit designs if delivered by Designated Diagnostic Providers. If a member has this benefit and receives services from a provider that is not a Designated Diagnostic Provider, services will be paid at the lowest tier/higher cost share according to their plan. UnitedHealthcare will build out access as necessary to help ensure members and physicians have access to Designated Diagnostic Providers.
Non-Designated Diagnostic Providers will remain in-network with UnitedHealthcare. For patients with Designated Diagnostic Provider benefit designs, patients may be liable for charges for outpatient diagnostic lab services.
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.
How it Works
Designated Diagnostic Providers are laboratories that meet broadly recognized quality and efficiency standards. UnitedHealthcare has invited all in-network free-standing and outpatient hospital laboratories to meet the quality and efficiency criteria to be a Designated Diagnostic Provider.
To meet the quality criteria, labs must complete a simple survey to demonstrate accreditation from more than one independent, industry-recognized organization that conducts quality reviews of labs (examples of such organizations recognized by United for DDP include the American Association for Laboratory Accreditation, College of American Pathologists or the Joint Commission).
Complete the Designated Diagnostic Provider lab quality questionnaire
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
Those facilities that do not meet the requirements to be a Designated Diagnostic Provider will remain in-network.
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 Provider Portal. Both give you instant access to the latest eligibility and benefits information in real-time without needing to pick up the phone. Within Provider Portal, you can also check coverage dates, policy information and detailed benefit information, as well as access digital ID cards.