Refer your patients to a Designated Diagnostic Provider

Lab 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.

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
  • For more information on Designated Diagnostic Providers, please refer to our frequently asked questions (FAQs). This FAQ is current as of July 1, 2021. We’ll be making updates to this site. Be sure to check back here for the latest information.
  • Designated Diagnostic Provider Map as of 8.2.2021