Many UnitedHealthcare benefit plan designs exclude from coverage outpatient diagnostic services that were not ordered by a participating physician. UnitedHealthcare benefit plans may also cover diagnostic services differently when a portion of the service (e.g., the draw) occurs in the physician’s office, but the analysis is performed by a laboratory provider. In addition, many state laws require that most, if not all, laboratory services are ordered by a licensed physician.
Therefore, all laboratory claims must include the NPI number of the referring physician, in addition to the other elements of a Complete Claim described in this Guide. Laboratory claims that do not include the identity of the referring physician will be rejected or denied.
This requirement applies to claims for laboratory services, both anatomic and clinical.
This requirement applies to claims received from both participating and non-participating laboratories, unless otherwise provided under applicable law. This requirement does not apply to claims for laboratory services provided by physicians in their offices. Please also refer to the Protocol on Use of Non-Participating Laboratory Services.