January 21, 2022

How to Become a Designated Diagnostic Provider for Imaging

UnitedHealthcare has created the Designated Diagnostic Provider Imaging – a tiered benefit design – to help members receive higher quality, more affordable imaging services.

Member coverage changes for this tiered benefit design go into effect on July 1, 2022 for major imaging services (CT, MRI, MRA, PET, nuclear medicine). We expanded our Designated Diagnostic Provider benefit designs to include these major imaging services on Jan. 1, 2022, subject to state regulatory approval, for fully insured commercial members.

Designated Diagnostic Providers maximize member benefits

The tiered benefit design will offer comprehensive network access and member engagement for a positive experience. We are using the standards of quality care established by accredited organizations for imaging services. Including these standards is an important step to improving the member experience and making health care more affordable.

The Designated Diagnostic Provider-based benefit designs will cover major diagnostic imaging services at the higher benefit level, lower cost share for members when delivered by a quality and cost-effective Designated Diagnostic Provider. Members can choose to receive services from an in-network non-Designated Diagnostic Provider and will still have coverage, but at a higher member cost share.

What action do I need to take?

All in-network free-standing and outpatient hospital imaging facilities, in approved states, will be invited to meet the quality and efficiency criteria to be a Designated Diagnostic Provider for Imaging. If you are a Designated Diagnostic Provider for lab services, you will need to meet the quality and efficiency requirements for imaging to become a Designated Diagnostic Provider for Imaging.

  • Complete the Imaging Designated Diagnostic Provider quality questionnaire
  • Connect with your network representative to discuss the efficiency requirements
  • If you meet the quality standards and efficiency requirements, you will become a Designated Diagnostic Provider for Imaging services and be notified accordingly. Starting July 1, 2022, our members and referring physicians will be able to recognize your facility as an approved Designated Diagnostic Provider facility in our provider directory.
  • There is not a specific deadline to return the questionnaire. However, completion by May 15, 2022 ensures your facility will be recognized in our directory starting July 1, 2022

Questions?
For more information, visit UHCprovider.com/ddp or contact your dedicated network representative. 

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