ANSWERS TO QUESTIONS SUBMITTED to UnitedHealthcare about the insurer’s laboratory benefit management program now coming into operation in Florida were provided by the company’s public communication officer. These answers are reproduced below:
Q: Will BeaconLBS process the claims that come through the BeaconLBS system or will UHC process those claims once they are approved by BeaconLBS?
A: UnitedHealthcare will send the in scope claims to BeaconLBS to apply any edits for Labs Of Choice, then UnitedHealthcare will apply benefit claim adjudication. BeaconLBS does not process the claims. They make any appropriate edits, then UnitedHealthcare finishes processing the claims.
Q: Will BeaconLBS pay the claims or will UHC pay the claims?
A: UnitedHealthcare will process all claims and provide remittance advice to all providers. For payment, UHC will pay UnitedHealthcare network and non‐network providers. BeaconLBS will pay its Laboratory of Choice providers. Beacon processes payments for Labs of Choice, and we process payments for all others.
Q: Does “claims impact” mean doctors might not get paid?
A: As of January 1, 2015, claims are subject to denial based upon the Lab Benefit Management policies and protocols. The ordering physician claims are not subject to denial. The additional time we are offering providers is so they can become familiar with the process and does not mean they will not get paid.
Q: Doctors have communicated with their medical associations about getting compensated for the additional time required to use the BeaconLBS system for ordering lab tests. Is there any plan by UHC to pay doctors for the time needed to use the system?
A: The provider will not be reimbursed for time spent using the BeaconLBS. BeaconLBS is working with those offices that have not started using Physician Decision support to understand and resolve issues, including increasing integration with EMRs by January 1, 2015.
Q: Some physicians have publicly stated that they plan to stop working with UnitedHealthcare because they find the BeaconLBS system to be time‐consuming and onerous. Has UHC or BeaconLBS heard from any physicians who say they want to drop UHC? And does anyone at UHC want to comment on this development or on the complaints we heard that doctors find BeaconLBS to be time‐consuming and onerous?
A: UnitedHealthcare continues to work with any physicians who have questions or concerns about the program.
Clients and regular readers of THE DARK REPORT who have questions or information about UnitedHealthcare’s laboratory benefit management program are invited to contact our editor in confidence.