LABORATORY PROVIDER CLAIM PROTOCOL
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This Protocol is adopted by UnitedHealthcare and all its affiliates. This Protocol
supplements the provisions of the Physician, Health Care Professional, Facility
and Ancillary Provider Administrative Guide and all other relevant
UnitedHealthcare affiliate provider manuals pertaining to laboratory claims.
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This Protocol applies only to claims for outpatient laboratory services, both
anatomic and clinical.
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This Protocol applies to claims received from both participating and nonparticipating laboratories, unless otherwise provided under applicable law.

This Protocol does not apply to claims for laboratory services provided by
physicians in their offices.
Laboratory Claim Submission Requirement:
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 office, but the analysis is performed by a laboratory
provider. In addition, many state laws require that most, if not all, laboratory services be
ordered by a licensed physician. It is therefore important that UnitedHealthcare verify
the referring physician for each laboratory claim.
Effective March 1, 2007, all laboratory claims must include the Unique Physician
Identification Number (UPIN) or National Provider Identifier (NPI) number of the
referring physician, in addition to the elements of a Clean Claim outlined in the
Administrative Guide. This requirement is consistent with current CMS policy. Like
CMS, UnitedHealthcare will also require that, effective May 23, 2007, all laboratory
claims include the NPI of the referring physician. Laboratory claims that do not
include the identity of the referring physician will be processed as though no physician
ordered the service. This may affect the level of benefits and payment associated with
the laboratory claim.