Monday, January 24, 2011

UnitedHealthcare to change reimbursement of non-network laboratory claims

Effective February 13, 2011, UnitedHealthcare (UHC) will reimburse non-participating outpatient laboratory claims based on the network status of the servicing laboratory. This applies to fully insured members whose employer groups are sitused in: AL, AR, AZ, CA, CT, DC, DE, GA, IA, ID, IN, KS,KY, LA, ME, MI, MS, NC, ND NE, NM, NV, OK, OR, RI, SC, SD, TN, UT, VA, WA, WI, WV, WY on a Certificate of Coverage 2002 or newer Choice Plus Insurance product (excluding HMO and EPO) with both network and non-network benefits.

Currently, claims for members who are using non-network outpatient laboratories are reimbursed based on the network status of their referring health care professionals.

By aligning the reimbursement of outpatient laboratory claims from non-network laboratories with the member's non-network benefits, as provided in the applicable Certificate of Coverage, UHC believes they will see:
• Potentially lower overall costs for laboratory services.
• The referral of members to network laboratory facilities to maximize benefits and provide access to affordable health care.
• Increased laboratory data used to support physician care plans through our disease management programs.

Notification
Letters regarding this policy were sent to affected members and network physicians at least 30 days prior to February 13, 2011.

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