2015-09-08 14:00:03 UTC

NY Members: UHC Implements New Lab Protocol

Sept. 7, 2015

GIs must notify UHC Oxford New York patients if their labs or pathology tests will be reviewed by an out-of-network lab.

New York State law requires physicians and other qualified health-care professionals to inform patients when referring them to a non-participating provider or including a non-participating provider in the patient’s health plan. And beginning Sept. 1, 2015, UnitedHealthcare (UHC) will require referral to, or use of, network laboratories and pathologists for UHC Oxford New York members for the following services:

  • Specimens collected in office and sent to an out-of-network laboratory or pathologist for processing.
  • Providing a member with a prescription, requisition or other form to obtain laboratory or pathology services outside your office.

If you collect specimens in your office and use a participating laboratory or pathologist for processing, there will be no additional requirements after Sept.1, 2015. If you do not, then prior to any referral to or the inclusion of an out-of-network laboratory or pathologist in a UHC Oxford New York member’s care, you must complete several requirements. These include discussing in- and out-of-network care provider options with the member, and providing them with a copy of the UHC Oxford Laboratory and Pathology Consent Form to complete indicating whether they wish to use an in-network or out-of-network pathologist or laboratory. 

A copy of the consent form must be kept in the member’s medical record. If UHC requests a copy of the consent form it must be provided within 15 days of the request. If not, the evaluation and management code from the office visit will be denied for noncompliance. Any payment previously made for the associated E/M service will be subject to recovery. UHC encourages participating physicians to set up an account with an UHC Oxford participating laboratory.

For more information, see page 46 of the UHC September bulletin.

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