UnitedHealthcare is dedicated to enhancing the healthcare experience for its members by focusing on improved health outcomes, reduced costs, and a better overall journey. A key initiative in achieving these goals is the Designated Diagnostic Provider (DDP) program for major imaging services. This program ensures that members receive high-quality, efficient, and importantly, in-network diagnosis for united health care, particularly when it comes to advanced imaging. By integrating quality standards recognized by accredited organizations, UnitedHealthcare is making healthcare more affordable and accessible without compromising on the excellence of diagnostic services.
For UnitedHealthcare members requiring major imaging services such as MRI, CT, PET scans, MRA, and nuclear medicine, utilizing a Designated Diagnostic Provider is the most cost-effective choice. This benefit design is structured to guide members towards facilities that meet stringent quality and efficiency benchmarks. While services remain accessible through non-Designated Diagnostic Providers within the UnitedHealthcare network, choosing a DDP ensures the lowest out-of-pocket expenses for these essential diagnostic procedures. This approach not only helps manage healthcare costs but also promotes the utilization of facilities recognized for their commitment to superior standards in imaging diagnosis.
Becoming a UnitedHealthcare Imaging Designated Diagnostic Provider: A 2-Step Process
For imaging facilities seeking to become a Designated Diagnostic Provider within the UnitedHealthcare network, a clear two-step process is in place, focusing on both quality standards and efficiency requirements.
The first step involves completing the Designated Diagnostic Provider Imaging Quality Questionnaire. This questionnaire serves as an initial assessment of the facility’s adherence to established quality benchmarks in imaging services.
Following the quality questionnaire review, UnitedHealthcare will engage with facilities to evaluate their efficiency requirements. Facilities that successfully meet both the quality and efficiency criteria will be officially recognized as a Designated Diagnostic Provider for imaging services within the UnitedHealthcare network. Notification of this designation will be provided directly by UnitedHealthcare.
For facilities that do not initially meet the DDP requirements, UnitedHealthcare is committed to providing support for improvement. A network representative will follow up to discuss specific quality and efficiency measures that need enhancement to achieve program qualification.
Designated Diagnostic Provider status offers increased visibility. An icon identifying participating facilities will be added to UnitedHealthcare’s provider and member directories. Referring providers can also easily identify DDPs through electronic medical records (EMR) using Point of Care Assist® or via the UnitedHealthcare Provider Portal, streamlining the referral process and ensuring patients are directed to in-network diagnosis options.
Benefit Design and Access to In-Network Diagnosis
The Designated Diagnostic Provider benefit design is being rolled out in phases. For UnitedHealthcare fully insured small group commercial plan members, this benefit became effective starting January 1, 2022, where approved. Large group commercial members gained access to this benefit beginning July 1, 2022. For other member groups, the Designated Diagnostic Provider benefit also went into effect on July 1, 2022.
This benefit structure means that members utilizing Designated Diagnostic Provider facilities – which include free-standing major imaging centers and hospital outpatient facilities meeting specific quality and efficiency standards – will benefit from a lower cost share. Conversely, choosing a facility that is not a Designated Diagnostic Provider will result in a higher member cost share, although services remain in-network. This design encourages members to actively choose In Network Diagnosis For United Health Care, optimizing both their healthcare dollars and access to high-quality imaging services.
Resources
Begin by completing the Designated Diagnostic Provider Imaging Quality Questionnaire
Point of Care Assist®
UnitedHealthcare Provider Portal
