IMS seeks clarification from UnitedHealthcare

Posted January 11, 2007

UnitedHealthcare has adopted a sanctioning policy for physician referral of lab work to labs outside their network. The protocol first requires physicians to use United participating labs unless otherwise authorized. IMS has asked United to reconfirm that its LabCorp exclusive applies in Iowa only to national referrals and not local lab use.

The United protocol further provides that beginning March 1, 2007, a physician who uses a non-network lab is subject to sanctions, including a financial penalty of $50, and/or a change in eligibility for United's Premium Designation Program, and/or a decreased fee schedule, and/or termination from network participation. IMS has raised several questions with United in a letter that was sent to United this month.