laboratory benefit management administrative protocol
TRANSCRIPT
UnitedHealthcare Laboratory Benefit Management Program Page 1 Insurance coverage provided by UnitedHealthcare Insurance Company or its affiliates. Administrative services provided by United HealthCare Services, Inc., its affiliates or designees. Doc#: PCA16547_20150413
UnitedHealthcare Laboratory Benefit Management Program
Administrative Protocol
This administrative protocol is effective Oct. 1, 2014.
This Laboratory Benefit Management Program Administrative Protocol applies to laboratory services for
fully insured Commercial members who live in Florida.
Excluded Plans
Benefit plans that are not subject to the requirements in this administrative protocol include:
Neighborhood Health Partnership
UnitedHealthcare Oxford Commercial and Medicare
Benefit plans subject to the UnitedHealthcare of the River Valley Entities Supplement
Sierra Health and Life
UnitedHealthcare Medicare Advantage
The Empire Plan
Railroad
MD-Individual Practice Association, Inc. (MD-IPA) and Optimum Choice, Inc.
Other benefit plans such as UnitedHealthcare Community Plan, Children's Health Insurance
Program (CHIP), uninsured and other non-Commercial plans
In addition, the Laboratory Benefit Management Program does not apply for claims subject to:
Optum Transplant Resource Services
Optum Cancer Resource Services
UnitedHealthcare StudentResources
Administration of the Program
Beacon Laboratory Benefit Solutions, Inc. (BeaconLBS®) will administer the Laboratory Benefit
Management Program on our behalf. BeaconLBS is a subsidiary of Laboratory Corporation of America®
that provides laboratory services management.
Member Identification Cards Members who are part of the Laboratory Benefit Management Program will be identified with a
BeaconLBS logo on their member identification (ID) card.
UnitedHealthcare Laboratory Benefit Management Program Page 2 Insurance coverage provided by UnitedHealthcare Insurance Company or its affiliates. Administrative services provided by United HealthCare Services, Inc., its affiliates or designees. Doc#: PCA16547_20150413
Physician Decision Support
As part of the Laboratory Benefit Management Program, ordering and rendering providers will use
BeaconLBS Physician Decision Support for laboratory services. Physician Decision Support technology
can make it easier to choose the right tests and laboratories for members using evidence-based guidelines
and industry best practices. If you order laboratory services and your practice is located in Florida, you
must use BeaconLBS Physician Decision Support when ordering any of the Decision Support Tests for
members who are part of the program. These tests are listed in this administrative protocol.
To access Physician Decision Support:
Use the standalone Physician Decision Support application available to registered users at
BeaconLBS.com.
Use an electronic laboratory ordering system integrated with Physician Decision Support.
Call 800-377-8809 (Monday ‒ Friday, 8 a.m. – 5 p.m. EST).
For a current list of electronic ordering systems integrated with Physician Decision Support, please go to
UnitedHealthcareOnline.com > Tools & Resources > Policies, Protocols and Guides > Protocols >
UnitedHealthcare Laboratory Benefit Management Program.
Physician Registration
Please register by visiting BeaconLBS.com and selecting Login|Register. You must register with
BeaconLBS to use the standalone Physician Decision Support application to order Decision Support
Tests. If you have already registered with BeaconLBS or if you submit test orders through a laboratory
ordering application integrated with Physician Decision Support, no further action is necessary.
If you do not use Physician Decision Support to order Decision Support Tests within 90 days after the
Laboratory Benefit Management Program effective date, you may be subject to one or more of the
following administrative actions:
A decreased fee schedule
Termination of your agreement with us
UnitedHealthcare will provide 30 days’ notice to care providers before enforcing these administrative
actions.
If your practice performs and bills for laboratory tests that are not Clinical Laboratory Improvement
Amendments (CLIA)-waived, you must also register as a laboratory.
Laboratory Registration
Please register by visiting BeaconLBS.com and selecting Login|Register. By registering with
BeaconLBS, ordering providers can select your laboratory for services when ordering tests through
Physician Decision Support.
Laboratory registration includes the following:
Document laboratory quality criteria.
Identify and map information for the Decision Support Tests you perform.
Prepare to submit laboratory test identifiers on claims.
UnitedHealthcare Laboratory Benefit Management Program Page 3 Insurance coverage provided by UnitedHealthcare Insurance Company or its affiliates. Administrative services provided by United HealthCare Services, Inc., its affiliates or designees. Doc#: PCA16547_20150413
Laboratory Quality Criteria If you perform and bill for any laboratory services, you must demonstrate the following:
CLIA certification
Accreditation from the College of American Pathologists (CAP) or The Joint Commission for
certain complex pathology tests
Secondary review for certain complex pathology tests
Sub-specialist review for certain complex pathology tests
Capability to process test orders and results electronically
Test Mapping Test mapping allows BeaconLBS to map tests in Physician Decision Support to your laboratory’s
clinically equivalent tests. As part of registration, you will map tests by submitting a test compendium
that includes the following information for Decision Support Tests:
Narrative description of the test
List of all associated Current Procedural Terminology (CPT) or Healthcare Common Procedure
Coding System (HCPCS) codes that correspond with each test identifier
Units of measure, specimen type, test method, specimen container, volume info, etc.
Number of units for each CPT or HCPCS code associated with each test identifier
BeaconLBS test identifier that corresponds to the laboratory’s unique test identifier
BeaconLBS will provide the form and data transmission protocol to submit the test identifier elements.
If your laboratory updates its test compendium after submission to BeaconLBS ‒ including any additions,
deletions or modifications ‒ you should provide updated information to BeaconLBS 30 days prior to
publishing those updates to providers, or as reasonably requested by BeaconLBS.
Laboratories of Choice
BeaconLBS Laboratories of Choice offer consistent clinical practices and cost efficiency. These
laboratories and other network laboratories that register and meet quality criteria for tests can be selected
for laboratory services using Physician Decision Support.
Laboratory of Choice providers must meet these quality criteria:
CLIA certification
CAP or Joint Commission accreditation for certain complex pathology tests
Secondary review for certain complex pathology tests
Sub-specialist review for certain complex pathology tests
In addition, Laboratories of Choice must have the capabilities to allow physicians to order and receive test
results electronically.
Laboratory of Choice providers must sign a contract with BeaconLBS and have their UnitedHealthcare
agreement amended to add BeaconLBS criteria.
To learn more about Laboratory of Choice providers, please visit UnitedHealthcareOnline.com > Tools &
Resources > Policies, Protocols and Guides > Protocols > UnitedHealthcare Laboratory Benefit
Management Program.
UnitedHealthcare Laboratory Benefit Management Program Page 4 Insurance coverage provided by UnitedHealthcare Insurance Company or its affiliates. Administrative services provided by United HealthCare Services, Inc., its affiliates or designees. Doc#: PCA16547_20150413
Claim Submission Process
You may only bill for covered services performed by you or your staff. Billing for laboratory tests
performed by another provider or laboratory is not permitted, with the exception of hospital and reference
laboratories following Centers for Medicare & Medicaid Services (CMS) policies regarding referred
laboratory testing. Claim submissions must include a CLIA number or CLIA Certificate of Waiver
number.
Clinical laboratory claims must contain the following:
o Your laboratory’s unique test identifier
o The ordering provider’s name and national provider identifier (NPI) number
o Your laboratory’s CLIA number
Hospital laboratory claims must contain:
o The ordering provider’s name and NPI number
Claim Submission Formats
A laboratory test identifier is an internal laboratory code used to identify a specific test performed by a
laboratory. Please use the following guidelines to submit test identifiers and other submission elements on
claims for members who are part of the Laboratory Benefit Management Program.
Claim Format and Elements
CLIA Number Location Options
Ordering Provider Name and NPI
Number Location Options
Test Identifier Submission Options
CMS-1500
(formerly
HCFA 1500)
Must be represented
in field 23
Submit the ordering provider name and NPI number in fields 17 and 17b, respectively.
Each time a laboratory CPT code or HCPCS code is populated in Item Number 24D, your corresponding test identifier should be placed in the shaded section of 24A through 24G.
UB04 or
CMS 1450
Not applicable for
UB04 or CMS 1450
claims
Submit the ordering provider name and NPI number in field 76.
Each time a laboratory CPT code or HCPCS code is populated in Field Location 44, your corresponding test identifier should be placed in Field Location 43.
HIPAA 5010
837
Professional
Must be represented
in the 2300 loop,
REF02 element
Submit the ordering provider name and NPI number in the 2310A loop, NM1 segment.
Each time a laboratory CPT code or HCPCS code is populated in the SV101-2 element of:
Loop 2400 Service Line Number
SV1 Professional Service Segment
Place your corresponding test identifier in the:
NTE02 element, with the ADD qualifier placed in the NTE01 element of:
o Loop 2400 Service Line Number
UnitedHealthcare Laboratory Benefit Management Program Page 5 Insurance coverage provided by UnitedHealthcare Insurance Company or its affiliates. Administrative services provided by United HealthCare Services, Inc., its affiliates or designees. Doc#: PCA16547_20150413
Claim Format and Elements
CLIA Number Location Options
Ordering Provider Name and NPI
Number Location Options
Test Identifier Submission Options
o NTE Line Note Segment
If multiple test identifiers are provided, please separate with commas.
Example: Submission of one laboratory test identifier (e.g., 002303) per procedure line: NTE *ADD*002303~
HIPAA 5010
837
Institutional
Not applicable for
institutional claims
Submit the ordering provider name and NPI number in 2310A loop, NM1 segment.
Each time a laboratory CPT code or HCPCS code is populated in the SV202-2 element of:
o Loop 2400 Service Line Number
o SV2 Institutional Service Line Segment
Place your corresponding test identifier in the SV202-7 element of:
o Loop 2400 Service Line Number
o SV2 Institutional Service Line Segment
If multiple test identifiers are provided, please separate with commas.
Example: Submission of one laboratory test identifier (e.g., 002303) for CPT 81099 with a billed amount of $125.15 and a unit of service of 1: SV2*0300*HC:81099:::::002303*125.15*UN*1~
This information describes specific requirements intended to supplement, not replace, all requirements in the ANSI X12N implementation guides. The ANSI X12N implementation guides are available at x12.org or www.wpc-edi.com.
Quality Criteria
Providers who perform and bill for laboratory services must meet the following quality criteria.
Laboratory quality criteria will be confirmed through the laboratory registration process.
UnitedHealthcare Laboratory Benefit Management Program Page 6 Insurance coverage provided by UnitedHealthcare Insurance Company or its affiliates. Administrative services provided by United HealthCare Services, Inc., its affiliates or designees. Doc#: PCA16547_20150413
Providers who do not meet all criteria for the tests performed and billed will not be reimbursed. Per your
agreement with UnitedHealthcare, these services may not be billed to the member.
CLIA: You must meet CLIA requirements and place your laboratory’s CLIA number on the claim for
services performed and billed.
Accreditation: You must have CAP or Joint Commission accreditation if you perform and bill for the
following services:
Surgical pathology
Cytology (gynecological and non-gynecological)
Molecular tests (e.g., genetics, infectious disease)
Flow cytometry
Advanced complex chemistry
Hematology and immunology procedures that require interpretation (e.g., electrophoresis, gas
chromatography, mass spectrometry)
The accreditation requirement does not apply at this time to providers with a specialty of dermatology or
dermatopathology who perform in-office pathology services. UnitedHealthcare will provide a 30-day
notice when the accreditation requirement goes into effect for care providers with a specialty of
dermatology or dermatopathology.
Sub-Specialty Certification:* If your laboratory performs and bills for the following services, you must
have the following corresponding sub-specialty certification. Certification may include board eligibility or
board certification.
Laboratory Testing Discipline Sub-Specialty Certification
General anatomic pathology Anatomic pathology
Bone marrow (smear, flow cytometry, cytogenetics)
Hematopathology
Chromosomal analysis Cytogenetics
Molecular genetics Molecular genetic pathology or certified geneticist
Cytology (Pap or fine needle aspiration smear)
Cytopathology
Malignant dermatopathology (excludes services associated with Mohs surgery)
Dermatopathology
Genetic counseling Board-certified genetic counselors
Human leukocyte antigen (HLA) testing American Society for Histocompatibility and Immunogenetics (ASHI) director
Secondary Complex Pathology Reviews:* If your laboratory performs and bills for pathology services,
you must provide secondary complex pathology review per the following chart.
* We recommend that care providers meet both the Sub-Specialty Certification and Secondary Complex Pathology
Reviews requirements. However, if both requirements cannot be met for dermatopathology, cytopathology or
hematopathology services, we will accept either requirement.
UnitedHealthcare Laboratory Benefit Management Program Page 7 Insurance coverage provided by UnitedHealthcare Insurance Company or its affiliates. Administrative services provided by United HealthCare Services, Inc., its affiliates or designees. Doc#: PCA16547_20150413
Secondary Complex Pathology Review Requirements
Area Description Quality Measure
Breast Pathology All new malignancies, atypical hyperplasia and in situ cases
Secondary review required; both reviews can be performed by general anatomic pathologist
Cytopathology All new malignancies to include gynecologic cytology, all fine needle aspirates, and non-gynecologic cytology
Secondary review required unless the initial review was performed by a cytopathologist. Both reviews can be performed by a general anatomic pathologist.
Dermatopathology New severely dysplastic nevi, melanomas, atypical spitz nevi, malignant skin appendageal tumors, atypical lymphoid infiltrates and soft tissue tumors diagnostic of sarcoma (excludes
services associated with Mohs surgery)
Secondary review required unless the initial review was performed by a dermatopathologist. Initial review may be completed by a dermatologist or an anatomic pathologist; secondary review be performed by an dermatopathologist or anatomic pathologist.
Gastrointestinal Pathology
New endoscopic directed biopsies and/or anal biopsy diagnostic of carcinoma; colon biopsies that have high grade dysplasia in a setting of inflammatory bowel disease; upper endoscopy directed biopsies with high grade dysplasia of either the stomach or esophagus; and liver needle biopsies regarded as diagnostic of carcinoma
Secondary review required; both reviews can be performed by general anatomic pathologist
General Pathology New miscellaneous biopsies (not encompassed in other categories) that are malignant or suspect cases (e.g., dysplastic nevi)
Secondary review required; both reviews can be performed by general anatomic pathologist
Gynecology Pathology
All new biopsies diagnostic of carcinoma to include vaginal and cervical biopsies, LEEP and cone biopsies, endocervical curettings and endometrial biopsies
Secondary review required; both reviews can be performed by general anatomic pathologist
Head, Neck and Oral Pathology
New biopsies diagnostic of in situ or invasive carcinoma of the mucosa, salivary gland, sinonasal tract to include inverted papillomas
Secondary review required; both reviews can be performed by general anatomic pathologist
Hematopathology New tissue biopsies with lymphoma to include intranodal and extranodal
Secondary review required unless the initial review was performed by a hematopathologist. Both reviews can be performed by a general anatomic pathologist.
Respiratory Pathology
New needle biopsies and endoscopic biopsies diagnostic of carcinoma
Secondary review required; both reviews can be performed by general anatomic pathologist
UnitedHealthcare Laboratory Benefit Management Program Page 8 Insurance coverage provided by UnitedHealthcare Insurance Company or its affiliates. Administrative services provided by United HealthCare Services, Inc., its affiliates or designees. Doc#: PCA16547_20150413
Uropathology All new genital-urinary biopsies to include kidney needle core biopsies** with in situ or invasive carcinoma
Secondary review required; both reviews can be performed by general anatomic pathologist
** It is recommended that biopsies within certain specialized areas (e.g., non-tumor kidney biopsies, ophthalmological biopsies or brain biopsies) be reviewed by pathologists with advanced training.
Advance Notification and Prior Authorization Requirements
Excluded Plans*
The following benefit plans are not subject to the Laboratory Benefit Management Program advance
notification and prior authorization requirements:
Benefit plans for which the member (rather than the physician) is required to provide advance
notification ‒ such as UnitedHealthcare Options PPO (for states other than Colorado) and
UnitedHealthcare Indemnity
UnitedHealthOne ‒ Golden Rule Insurance Company only
All Savers products offered off-exchange
MD-Individual Practice Association, Inc. (MD-IPA)
Optimum Choice, Inc. (OCI), OCI Health Savings Account (HSA) or OneNet
UnitedHealthcare West
* The Laboratory Benefit Management Program advance notification and prior authorization
requirements will not apply to these benefit plans. However, these benefit plans may have separate
advance notification and prior authorization requirements. For more information, please refer to the
applicable Additional Manual in the Benefit plans table of the UnitedHealthcare Administrative Guide at
UnitedHealthcareOnline.com > Home > Tools & Resources > Policies, Protocols and Guides.
Advance Notification
Advance notification is required for Decision Support Tests rendered in the office (place of service 11) or
clinical laboratory (place of service 81). If advance notification is not confirmed for Decision Support
Tests, the test will not be eligible for payment.
This protocol is a notification requirement, not a precertification, prior authorization or medical necessity
determination. The participating physician (ordering provider) must notify UnitedHealthcare using
Physician Decision Support prior to ordering the service.
The rendering laboratory will receive advance notification confirmation in the Outcome Summary or at
BeaconLBS.com. The Outcome Summary is a printable onscreen message that includes test ordering
results when a Decision Support Test is ordered through:
Physician Decision Support (available to registered users at BeaconLBS.com);
An electronic laboratory ordering system integrated with Physician Decision Support; or
Phone: 800-377-8809 (Monday ‒ Friday, 8 a.m. – 5 p.m. EST)
Please note that you will not be able to request advance notification through
UnitedHealthcareOnline.com.
UnitedHealthcare Laboratory Benefit Management Program Page 9 Insurance coverage provided by UnitedHealthcare Insurance Company or its affiliates. Administrative services provided by United HealthCare Services, Inc., its affiliates or designees. Doc#: PCA16547_20150413
If the rendering laboratory confirms that advance notification is not on file, the rendering laboratory
should contact the ordering provider to complete the notification process. Advance notification must be
completed within 10 calendar days from the date of service. The date of specimen collection is the date of
service. You cannot request advance notification after the claim has been submitted or request batch
notifications.
Advance notification cannot be confirmed unless the entire advance notification process is completed.
Advance notification is valid for 60 days from the date of test order. If the date of service exceeds 60
days, a new notification must be obtained.
For additional details please go to UnitedHealthcareOnline.com > Tools & Resources > Policies,
Protocols and Guides > Protocols > UnitedHealthcare Laboratory Benefit Management Program. A list of
Decision Support Tests is included in this administrative protocol.
Physician Decision Support is a laboratory services ordering tool operated by Beacon LBS. Successful
completion of an order or notification in Physician Decision Support is not a guarantee of payment or
coverage. Beacon LBS does not authorize or deny coverage for services. Information provided on
Physician Decision Support and by BeaconLBS representatives about payer clinical policies is for
informational purposes only. UnitedHealthcare clinical policies are available to physicians at
UnitedHealthcareOnline.com.
Prior Authorization
For any tests requiring prior authorization, ordering providers must use Physician Decision Support to
request prior authorization before ordering the service. Physician Decision Support will send the
information to UnitedHealthcare, and we will review the clinical information, make a determination and
communicate the decision.
The rendering laboratory will receive advance notification confirmation in the Outcome Summary or at
BeaconLBS.com. If the rendering laboratory confirms that prior authorization has not been requested, the
rendering laboratory should contact the ordering provider to complete the prior authorization process.
No updates can be made to an existing prior authorization after the service has been delivered.
Prior authorization requests for members who are not part of the Laboratory Benefit Management
Program should follow the standard process.
Decision Support Tests
Decision Support Tests are subject to separate requirements outlined in the previous sections of this
administrative protocol. All Decision Support Tests require advance notification using Physician Decision
Support. The BRCA 1/BRCA 2 test requires prior authorization.
For some Decision Support Tests, advance notification includes validating the following requirements:
Ordering provider: Completion of an electronic question and answer (Q&A) through Physician
Decision Support
Rendering provider: CAP or Joint Commission accreditation, sub-specialty certification and/or
secondary pathology review
The following chart outlines the validation requirements by laboratory test.
UnitedHealthcare Laboratory Benefit Management Program Page 10 Insurance coverage provided by UnitedHealthcare Insurance Company or its affiliates. Administrative services provided by United HealthCare Services, Inc., its affiliates or designees. Doc#: PCA16547_20150413
Decision Support Test Electronic Q&A
CAP or Joint Commission accreditation
Sub-specialty certification
Secondary pathology
review
Allergen panel
Alpha-thalassemia Yes Yes Yes; certified geneticist or molecular pathologist
Anemia panel, comprehensive Yes
Antineutrophil cytoplasmic antibody (ANCA) profile
Yes
Antinuclear antibodies (ANA) Yes
ANA panel (includes specific connective tissue antibodies)
Yes
Beta-hemolytic Streptococcus culture, group A
BRCA 1/BRCA 2* Yes*
Yes
Cancer antigen (CA) 125
CD4/CD8 cells (percent and absolute) + ratio
Yes
Chlamydia trachomatis/Neisseria gonorrhoeae with or without Trichomonas vaginitis, nucleic acid test (NAT)
Yes
Chromosome, blood (constitutional), pediatric (non-prenatal/POC)
Yes Yes Yes; cytogenetic or
American Board of Medical Genetics (ABMG)-certified director
Chromosome SNP microarray panel
Yes Yes Yes; cytogenetic or ABMG-certified
director
Clostridium difficile toxins A and B, EIA
Yes
Cystic fibrosis extended panel Yes Yes Yes; certified geneticist, molecular
pathologist or ABMG-certified
director
Cystic fibrosis panel (non-extended)
Yes Yes Yes; certified geneticist, molecular
pathologist or
UnitedHealthcare Laboratory Benefit Management Program Page 11 Insurance coverage provided by UnitedHealthcare Insurance Company or its affiliates. Administrative services provided by United HealthCare Services, Inc., its affiliates or designees. Doc#: PCA16547_20150413
Decision Support Test Electronic Q&A
CAP or Joint Commission accreditation
Sub-specialty certification
Secondary pathology
review
ABMG-certified director
Drug screen and/or confirmation testing
Yes
Factor V Leiden mutation analysis
Yes Yes Yes; ABMG-certified director
Fine needle aspiration cytology Yes Yes; cytopathologist
Yes
Free kappa+lambda light chains, quantitative
Yes
Genital culture, routine
Gynecological Pap test with or without additional tests for sexual transmitted diseases (STDs)
Yes Yes Yes; cytopathologist
Gynecological Pap test with or without additional tests for STDs and reflex to human papillomavirus (HPV)
Yes Yes Yes; cytopathologist
Gynecological Pap test with HPV, and with or without additional tests for STDs
Yes Yes Yes; cytopathologist
Helicobacter pylori, IHC Yes
Helper T-lymphocyte markers (includes CD3 and CD4 percent and absolute)
Yes
Hemoglobinopathy fractionation profile
Yes
Hepatitis B and C profile Yes
Hepatitis B virus (HBV) quantitative, NAT
Yes Yes
Hepatitis C virus (HCV) FibroSURE
Yes
HCV genotype Yes Yes
HCV quantitative, NAT Yes Yes
Hereditary hemochromatosis, DNA analysis
Yes Yes Yes; certified geneticist or molecular pathologist
Herpes simplex virus (HSV) antibodies
HSV culture and typing Yes
HLA B27 Yes
Human immunodeficiency virus (HIV-1) genotyping
Yes Yes
UnitedHealthcare Laboratory Benefit Management Program Page 12 Insurance coverage provided by UnitedHealthcare Insurance Company or its affiliates. Administrative services provided by United HealthCare Services, Inc., its affiliates or designees. Doc#: PCA16547_20150413
Decision Support Test Electronic Q&A
CAP or Joint Commission accreditation
Sub-specialty certification
Secondary pathology
review
HIV-1 1/O/2 antibodies screening with confirmation
Yes
HIV-1, quantitative, RNA Yes Yes
HPV, high-risk DNA detection Yes Yes
Insulin-like growth factor 1 (IGF-1) Yes
Immunofixation (IFE) and protein electrophoresis
Yes
IFE Yes
Immunohistochemistry (IHC) Yes
Leukemia/lymphoma immunophenotyping profile (by flow cytometry)
Yes
Lipoprotein analysis by NMR
Lipoprotein subfractionation profile by ultracentrifugation
Lyme disease antibodies with reflex confirmation
Yes
Lyme disease, Western blot Yes
Microbiology special stain, histology
Yes
Miscellaneous cytology (e.g., fluids, smears, sputum)
Yes Yes; cytopathologist
Yes
Ova + parasite exam
Pathology ‒ breast Yes Yes
Pathology ‒ dermatopathology Yes Yes; dermato-pathologist
Yes
Pathology ‒ gastrointestinal Yes Yes
Pathology ‒ general Yes Yes
Pathology ‒ gynecology Yes Yes
Pathology ‒ hematopathology Yes Yes; hemato-pathologist
Yes
Pathology ‒ otolaryngology Yes Yes
Pathology – respiratory Yes Yes
Pathology ‒ uropathology (including urine cytology)
Yes Yes
Prostate biopsy Yes Yes
Protein electrophoresis Yes
Quadruple marker screen – prenatal (AFP, DIA, hCG, uE3)
Yes Yes Yes; ABMG-certified director
Stool culture
Strep group B culture/DNA Yes Yes
Syphilis screen, qualitative, with confirmation
Yes
Systemic lupus erythematosus profile
Yes
Thyroid panel Yes
UnitedHealthcare Laboratory Benefit Management Program Page 13 Insurance coverage provided by UnitedHealthcare Insurance Company or its affiliates. Administrative services provided by United HealthCare Services, Inc., its affiliates or designees. Doc#: PCA16547_20150413
Decision Support Test Electronic Q&A
CAP or Joint Commission accreditation
Sub-specialty certification
Secondary pathology
review
Thyroid-stimulating immunoglobulin (TSI)
Yes
Thyroxine (T4), free Yes
T-lymphocyte helper/suppressor profile (C4/C8)
Yes
Triiodothyronine (T3), free Yes
Triple marker screen – prenatal (AFP, hCG, uE3)
Yes Yes Yes; ABMG-certified director
Urine cytology Yes
Urine cytology hematuria profile Yes
UroVysion Yes Yes
Vaginitis/vaginosis, NAT Yes
Vitamin D, 25-hydroxy
* Prior authorization required
UnitedHealthcare Laboratory Benefit Management Program Page 14 Insurance coverage provided by UnitedHealthcare Insurance Company or its affiliates. Administrative services provided by United HealthCare Services, Inc., its affiliates or designees. Doc#: PCA16547_20150413
For More Information
Resource Where to go What you can do there
UnitedHealthcare Online: UnitedHealthcareOnline.com Phone: Please refer to the phone number on the member ID card
Learn more about the Laboratory Benefit Management Program at UnitedHealthcareOnline.com > Tools & Resources > Policies, Protocols and Guides > Protocols > UnitedHealthcare Laboratory Benefit Management Program.
Verify claim payment status and submit a claim appeal for certain outpatient laboratory test services as described in the Advance Notification and Prior Authorization Requirements section of this administrative protocol.
BeaconLBS Online: BeaconLBS.com Phone: 800-377-8809 (Monday ‒ Friday, 8 a.m. – 5 p.m. EST)
View program information.
Register for the Laboratory Benefit Management Program.
Request participation in the Laboratory of Choice network, if interested. If you are already a Laboratory of Choice provider, contact BeaconLBS for questions about your contract, including reimbursement.
Access the standalone Physician Decision Support tool and technical support.