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UnitedHealth Sets More Billing Rules for Labs, Pathologists

UHC seeks refunds for some prostate biopsies and requires member consent for out-of-network referrals

SUBMITTING CLINICAL LABORATORY AND PATHOLOGY TEST CLAIMS to UnitedHealthcare (UHC) will be more complex after the nation’s largest health insurer announced three significant changes in its claims processing procedures. The three changes involve: • Requests for refunds from anatomic pathology (AP) groups that UHC says may have submitted incorrect claims for biopsies, • Rules for out-of-network referrals, and • More tests needing prior …

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