September 06, 2017
Area(s) of Interest: Commercial Payors Practice Management
The California Medical Association (CMA) is concerned that United Healthcare (UHC) failed to properly notify physicians before implementation of its Clinical Data Submission Protocol. Although California law (California Insurance Code §10133.65 and Health & Safety Code §1375.7) requires payors to provide contracted physicians with the 45 business days’ advance notice of any material contracting changes, UHC's only notification to physicians about this new protocol was in its Network Bulletin.
First introduced in 2015, the program originally targeted only Medicare benefit plans and required physicians to submit all laboratory test results for UHC Medicare patients. The expansion of the program will require practices to submit laboratory tests for all UHC Medicaid and commercial benefit plans. UHC has stated, however, that it will help practices establish the transmission method that works best with their current capabilities.
At the request of CMA, UHC delayed the expansion of its Clinical Data Submission Protocol in California. Originally scheduled to take effect July 1, 2016, the expansion was pushed back until September 2. However, CMA believes UHC is not compliant with state law as it has not formally notified all affected physician practices of changes to the protocol. CMA is evaluating its next steps and will update physicians when additional information is available.
While UHC lauds the sharing of clinical patient data as an opportunity to support quality and cost-effective patient care, CMA is also concerned about the administrative burden of the protocol and the impact on physician practices.
For more information about the protocol and requirements for submitting data to UHC, physicians should refer to the updated Clinical Data Submission Protocol FAQ and Methods of Clinical Data Exchange, or contact either the UHC Provider Call Center at (877) 842-3210 or their local UHC Network Account Manager or Provider Advocate.