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