College of American Pathologists Presses UHC to Extend Delay
The nation’s largest health insurer, UnitedHealthcare (UHC), announced earlier this year that in order to bill for services, laboratories will need to register all of its tests with the provider. It recently extended the deadline for submissions to the registry from September 1, 2020, to December 1, 2020.
Beginning January 1, 2021, the insurer will deny claims that do not include the lab’s registered test code. In addition to requiring the lab’s unique test code, the insurer states, “Each test code submitted on a claim must match a corresponding laboratory test registration provided in advance to us, or we will deny the claim.” UHC cautions that inclusion of test codes on a claim does not guarantee payment of the claim, only that exclusion of the test codes will result in non-payment.
The new mandate applies to free-standing, in-network and outpatient hospital lab providers and effectively impacts all UnitedHealthcare commercial and Medicare Advantage networks as well as most community plan networks.
Independent labs (place of service 81) and outpatient labs (place of service 22) that are in-network with UHC must comply with the new protocol. The only noted exceptions include:
Tests that require prior authorization by the Genetic and Molecular Lab Testing Notification/Prior Authorization Process
Tests that require placement of the National Institutes of Health (NIH) Genetic Testing Registry (GTR) ID; this exception follows the UHC Molecular Pathology Reimbursement policy.
Test services provided by outpatient physician office laboratories (place of service 11)
Citing the added strain of coping with the COVID-19 pandemic, the College of American Pathologists (CAP) has stated that it will object to implementation of the registry. In its weekly advocacy update, CAP Statline, the association stated plainly, “Now is not the time to move forward with new billing rules and potentially further disrupt revenues by denying claims for tests.”
To assist our laboratory clients impacted by this new protocol, Quadax will be gathering resources into an easy-to-use guide for labs. Resources will include information on the UHC test registry process and methods to facilitate test code inclusion on claims processed through Quadax’s EDI products and revenue cycle solutions.
Developing tools and counseling on strategies to address barriers to payment or disruptive forces in the revenue cycle, like the COVID-19 pandemic, are among Quadax’s core competencies. Labs looking for a partner to navigate the UHC registry, COVID-19 reimbursement or improve revenue cycle management, in general, are encouraged to schedule a strategy call and start maximizing reimbursement.
Senior Vice President
Revenue Cycle Service Support
Revenue Cycle Tech Support