Beginning Oct. 1, United Healthcare (UHC) will require labs to provide unique test codes on claims for in-scope services.
In order to comply, lab providers must register their lab tests BEFORE Sept. 1, 2020.
Lab test codes must be on claims for in-scope lab test services. The codes will serve as the lab’s unique identifier that a physician would use to order a test (aka “test code, “order code, or “test identifier”). Claims without the codes may be denied.
According to UHC’s provider FAQ: “a laboratory test code is a laboratory’s unique identifier that a physician would use to order a test. This should uniquely identify the test offered by the laboratory and correspond to what the physician ordered, whether it was a single test that is ultimately billed as a single procedure code or a test “panel” that ultimately bills as multiple procedure codes.”
Laboratory testing services covered by this protocol include ALL freestanding and outpatient hospital laboratory testing services EXCEPT for:
- Lab test services requiring notification/prior authorization by the Genetic and Molecular Lab Testing Notification/Prior Authorization Process.
- Lab test services requiring placement of the National Institutes of Health (NIH) Genetic Testing Registry (GTR) ID (per UHC’s Molecular Pathology Reimbursement policy).
- Lab test services rendered by outpatient physician office laboratories (i.e., those billing place of service 11).
This means place of service 81 (independent labs) and 22 (outpatient) are included under this protocol if they are in-network with United Healthcare.
What do you need to do now?
We are currently in the process of communicating with billers to determine individual applicability/information that may be needed in order to appropriately register the lab test. Further communication from your biller should take place in the coming weeks.
If you are billing in-house, Vachette is available for guidance, if necessary. 517-486-4262.