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Hospital Reference Lab Protocol

For claims paid on or after May 1, 2020, hospitals acting as a Reference Laboratory or conducting diagnostic testing for non-patients cannot bill for such non-patient diagnostic laboratory tests under that hospital’s Facility Participation Agreement. Hospitals wishing to participate in UnitedHealthcare‘s commercial network as a Reference Laboratory may apply with UnitedHealthcare to be credentialed and contracted as a Reference Laboratory.

Definitions

  • Reference Laboratory: A laboratory that performs diagnostic testing on specimens it receives from other referring laboratories or care providers.
  • Non-patient: Is a member that is neither an inpatient nor an outpatient of a hospital, but for whom a specimen is submitted for laboratory testing to a hospital.

What Hospitals Need to Do

To contract your hospital as a Reference Laboratory, please contact your network representative to begin the credentialing and contracting process.

Claims submitted for non-patient diagnostic laboratory tests, or claims where a hospital is acting as a Reference Laboratory, will be denied for failure to comply with this protocol in the event a hospital is billing under its Facility Participation Agreement.

Questions

If you have questions, please contact your network representative.