Dear Physician, The United Healthcare® Laboratory Benefit Management Program, administered through BeaconLBS® requires advanced notification for the 81 tests listed on the reverse side. You can conveniently complete advanced notification through the following options: Advanced Notification Options LabCorp® or Millennium Laboratories® • LabCorp Beacon® ordering system • LabCorp LCM ordering system Cloud-based ordering system EHR ordering systems Email [email protected] for more information. BeaconLBS® Portal at www.BeaconLBS.com and click the Login | Register button • Emdeon® Available • GE Centricity®/Liaison® Available • Allscripts® Anticipated Availability – November 2014 • eLabCorp® ordering system • Aprima® Anticipated Availability – November 2014 • Millennium Laboratories® ordering system • eClinicalWorks® Limited Availability – November 2014 Automated Phone Notification: Only Available for these Laboratories 800-377-8809 The advanced notification requirement can be completed via automated phone for Labs-of Choice. Follow these prompts: 1. Say or Press 1 for UnitedHealthcare 2. Say or Press 1 for a “physician’s office” 3. Say or Press 1 for Advanced Notification 4. Say or Enter Provider’s NPI 5. Say or Enter Subscriber number 6. Say or Enter DOB (MM/DD/YYYY) 7. Say or Enter Diagnosis Code 8. Say or Enter 1 for Clinical or 2 for Pathology Clinical Notification 9. Say or Enter Lab-of-Choice Test code(s) 10. Submit Notification Pathology Notification 9. Choose Lab-of-Choice Pathology Lab 10. Submit Notification Bako Broward Health Clarient Dianon Pathology Dominion Granite Laboratories Gulf Coast Dermatopathology Integrated Genetics Integrated Oncology KWB Pathology LabCorp MedTox Laboratories Millenium If you are providing Notification for Pathology say or press one of the following labs: 1. 2. 3. 4. 5. 6. 7. 8. Bako Broward Health Dianon Pathology Gulf Coast Dermatopathology KWB Pathology LabCorp Integrated Oncology MedTox Laboratories UnitedHealthcare Tests Requiring Advanced Notification Allergen panel Chromosome SNP microarray panel Helicobacter pylori, IHC HIV-1 1/O/2 antibodies screening with confirmation Lyme disease, Western blot Pathology – uropathology (including urine cytology) T-lymphocyte helper/ suppressor profile (C4/C8) Alpha-thalassemia Clostridium difficile toxins A and B, EIA Helper T-lymphocyte markers (includes CD3 and CD4 percent and absolute) HIV-1, quantitative, RNA Microbiology special stain, histology Prenatal profile Triiodothyronine (T3), free Anemia panel, comprehensive Cystic fibrosis extended panel Hemoglobinopathy fractionation profile Human leukocyte antigen (HLA) B27 Miscellaneous cytology (e.g., fluids, smears, sputum) Prostate biopsy Triple marker screen – prenatal (AFP, hCG, uE3) Antineutrophil cytoplasmic antibody (ANCA) profile Cystic fibrosis panel (nonextended) Hepatitis B and C profile HPV, high-risk DNA detection Ova + parasite exam Protein electrophoresis Urine cytology Antinuclear antibodies (ANA) Factor V Leiden mutation analysis Hepatitis B virus (HBV) quantitative, NAT Immunofixation electrophoresis (IFE) Pathology – breast Quadruple marker screen – prenatal (AFP, DIA, hCG, uE3) Urine cytology hematuria profile ANA panel (includes specific connective tissue antibodies) Fine needle aspiration cytology Hepatitis C virus (HCV) FibroSURE IFE and protein electrophoresis Pathology – dermatopathology Stool culture Urine drug screen with confirmation Beta-hemolytic Streptococcus culture, group A Free kappa + lambda light chains, quantitative HCV genotype Immunohistochemistry (IHC) Pathology – gastrointestinal Strep group B culture/DNA UroVysion BRCA1/BRCA2* Genital culture, routine HCV, quantitative, NAT Insulin-like growth factor 1 (IGF-1) Pathology – general Syphilis screen, qualitative, with confirmation Vaginosis/vaginitis, NAT Cancer antigen (CA-125) Gestational diabetes onehour screen Hereditary hemochromatosis, DNA analysis Leukemia/lymphoma immunophenotyping profile (by flow cytometry) Pathology – gynecology Systemic lupus erythematosus profile Vitamin D, 25-hydroxy CD4/CD8 cells (percent and absolute) + ratio Gynecological Pap test with or without additional tests for sexual transmitted diseases (STDs) Herpes simplex virus (HSV) antibodies Lipoprotein analysis by NMR Pathology – hematopathology Thyroid panel Chlamydia trachomatis / Neisseria gonorrhoeae with or without Trichomonas vaginalis, nucleic acid test (NAT) Gynecological Pap test with human papillomavirus (HPV), and with or without additional tests for STDs HSV culture and typing Lipoprotein subfractionation profile by ultracentrifugation Pathology – otolaryngology Thyroid-stimulating immunoglobulin (TSI) Chromosome, blood (constitutional), pediatric (non-prenatal/POC) Gynecological Pap test with or without additional tests for STDs and reflex to HPV Human immunodeficiency virus (HIV-1) genotyping Lyme disease antibodies with reflex confirmation Pathology – respiratory Information You May Find Helpful: The program applies to fully-insured Florida commercial members. Physicians are required to comply with the program. Additional requirements can be found at www.unitedhealthcareonline.com Home > Tools & Resources > Policies, Protocols and Guides > Protocols > UnitedHealthcare Laboratory Benefit Management Program Thyroxine (T4), free *Requires Prior Authorization Brands listed are trademarks of their respective owners.