February 07, 2018
Area(s) of Interest: Commercial Payors Patient Care Payor Issues and Reimbursement
UnitedHealthcare (UHC) announced in its January 2018 Network Bulletin that it will begin enforcing stricter notification requirements related to out-of-network laboratory referrals. According to the bulletin, physicians wishing to utilize an out-of-network laboratory will be required to obtain a completed UHC Member Advance Notice Form from patients authorizing the referral to the non-participating laboratory. The new policy does not apply to emergencies.
The California Medical Association (CMA) raised concerns with a similar UHC process implemented in August 2016 involving completion of the Member Advance Notice Form prior to utilization of an out-of-network ambulatory surgical center. In response to CMA’s concerns, UHC issued a notification to physicians clarifying when UHC will request that physicians submit a copy of the completed Member Advance Notice Form at the time of prior notification to the payor. CMA is inquiring with UHC whether a similar requirement will be applied to the new out-of-network laboratory referral process.
More information regarding this change can be found in the UnitedHealthcare Administrative Guide 2018 located on the UHCProvider.com website. Providers can also contact UHC at (866) 574-6088 for additional information.