UnitedHealthcare Designated Diagnostic Provider Program Begins July 1

July 14, 2021 By: Quadax

Labs Must Complete Programmatic Registration Process by February 28

7/1/2021 - UPDATE: UnitedHealthcare Delays Test Registration Indefinitely.

UnitedHealthcare recently announced its intention to implement what it is calling a “Designated Diagnostic Provider” program (DDP). Per the company, the DDP is designed to “reduce member cost and improve transparency.” The program is slated to begin July 1, 2021, pending state regulatory approval. To be eligible for coverage, outpatient laboratories are required to complete a Lab Quality Questionnaire by February 28, 2021.

The new program is not without controversy. In a sharply worded letter, the American Hospital Association (AHA) urged the Federal Trade Commission (FTC) to investigate the DDP program, arguing that it “is attempting to redefine the concept of an ‘in-network’ provider and limit patient access to a much smaller pool of laboratory service providers.” The AHA expressed concern that the conflicting requirements for in-network service will create confusion for patients and may “result in cost-sharing obligations beyond the limits established under federal law.”

In the absence of any binding legal challenges to the DDP, Quadax recommends that diagnostic labs take the necessary steps to qualify for reimbursement coverage under the program rules.

DDP Program Fast Facts

Per the UnitedHealthcare DDP program web page:

  • Outpatient diagnostic lab services will only be covered for members with UnitedHealthcare Designated Diagnostic Provider benefit designs if delivered by Designated Diagnostic Providers
  • Non-Designated Diagnostic Providers will remain in network with UnitedHealthcare, but outpatient diagnostic lab services will deny as non-covered for members with Designated Diagnostic Provider benefit designs and patients may be liable for charges
  • Lab services rendered as part of inpatient admissions, emergency room visits or outpatient surgery pre-operation testing that is billed as part of a global surgical package are not subject to the DDP restrictions

How to participate in the UnitedHealthcare Designated Diagnostic Provider (DDP) Program

Qualification for the DDP will be based on a lab’s ability to meet undisclosed quality and efficiency requirements. To become a Designated Diagnostic Provider, labs must complete a Lab Quality Questionnaire by February 28, 2021. UnitedHealthcare will process the questionnaire and deliver one of two outcomes:

  • Labs that meet the requirements will become a Designated Diagnostic Provider. The provider will notify qualifying labs of their status
  • Labs that do not meet the requirements will be contacted by a dedicated network representative

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