United Healthcare moves to designated provider program

2019 07 09 22 10 3802 Doctor X Ray 400

On July 1, 2022, United Healthcare will begin to implement its Designated Diagnostic Provider (DDP) program for imaging facilities in certain states. According to United's FAQ document, outpatient MRI/MR angiography, CT, PET, and nuclear medicine scans must be performed by a Designated Diagnostic Provider in order for members to have the lowest out-of-pocket cost. A member will pay more for services provided by non-DDP imaging facilities.

Sandy Coffta.Sandy Coffta.

United will place those providers who meet their minimum criteria for quality and efficiency in tier 1 (Designated Diagnostic Providers), and those who do not in tier 2 (non-DDP). United's web site does not indicate what the "minimum criteria" will be, but the American College of Radiology (ACR) reports that United's self-attestation survey includes the following quality measures:

  • Accreditation status
  • Timeliness of care and test results
  • Submission of electronic images

Efficiency will be measured by cost, with all providers having the same cost target regardless of practice setting.

The program does not apply to x-ray, ultrasound, or mammography imaging, or to imaging services performed in an emergency room, observation event, or an inpatient admission. It also does not apply to Medicare, Medicaid, or certain other plans administered by United.

Since all the services within the scope of the DDP program require prior authorization, United will advise the ordering physician and the patient of the facility's status at the time the authorization is obtained. DDP facilities will also be identified in United's provider directory.

The ACR encourages its members to act as soon as possible to become part of the program. Providers in the approved states already received an invitation from United to complete an online survey, which is directed to facilities rather than to individual radiologists.

Accordingly, the survey should be completed by imaging centers, and hospital-based groups should verify that their institution has taken the necessary steps to become a DDP. The 25 states where the DDP program is currently permitted by insurance regulations are the following:

South Carolina
Washington, DC
West Virginia

United has been using its DDP program for laboratory services since 2021, and it is seeking to expand both the laboratory and the imaging program into other states as they obtain regulatory approval. The program is being promoted by United to "help manage costs and improve access to quality care by connecting patients to major imaging services that have met certain quality and cost-efficiency criteria."

We expect that United will contact physicians in each new state that comes into the program to complete the survey and be assigned DDP status, or not.

Sandy Coffta is the vice president of client services at Healthcare Administrative Partners.

The comments and observations expressed are those of the author and do not necessarily reflect the opinions of AuntMinnie.com.

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