Lab and Imaging services will be paid at a higher tier/lower cost share for members when delivered by a Designated Diagnostic Provider. 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.
This change will apply to fully insured commercial plan members as plans renew, in approved states.
Confident care at a lower cost for patients
When you refer patients to a Designated Diagnostic Provider, you:
- Optimize patient health: Build trust with patients by working with them to make informed health care decisions and helping them save money by referring them to Designated Diagnostic Providers
- Improve transparency: Demonstrate to patients that you are an active partner in helping them understand their options, getting care and avoiding spending too much
- Lower costs: Identifying Designated Diagnostic Providers when you’re making referrals helps your practice avoid rework (calls from patients later looking for additional referral options), eliminate patient frustration (finding out referrals are out-of-network) and help lower overall medical costs
Check eligibility and find a Designated Diagnostic Provider
Point of Care Assist
- Use Point of Care Assist® in your electronic medical records (EMR) workflow to instantly check a patient’s eligibility and see a list of Designated Diagnostic Providers available to your patient
Provider Portal
- Check your patient’s eligibility electronically or member ID card to see if they have a Designated Diagnostic Provider benefit plan
- Use the Provider Directory to find a list of Designated Diagnostic Providers available to your patient
Resources
- Watch the online course to learn how to refer your patients to the appropriate place for care