FAQ's: Optum E-Labs

Healthie has integrated with third-party partners to enable the fulfillment of E-Labs within Healthie and for streamlined coordination across the Lab Companies, our organizations, and your clients. 

This article contains information on Healthie's integration with Optum for lab ordering. 

How will payment work for Labs ordered through the integration? 

There are three billing options supported by Optum per connected laboratory (subject to a lab company's specific requirements and capabilities):

• Client (Lab Bills Medical Clinic)
• Patient (Lab Bills Patient)
• Third party (Lab bills insurance)

Is there a cost for Optum E-Labs? 

Optum doesn’t charge customers a fee for using their services via Healthie. Customers will still need to have an account with the individual labs eg. Quest, Labcorp, etc. and will pay for labs based on each individual lab's pricing model, where it’s likely the customer, the patient, or insurance will need to cover the cost of the lab. To confirm, we recommend talking to both Optum and any labs you plan to order from.

For Healthie Enterprise customers, there is no implementation fee but you will be charged an ongoing fee of $10 per provider enrolled per month. You are responsible for reaching out if you'd like us to remove providers from your account.

How long will the lab enrollment process take? 

For non-Quest and Labcorp requests, Optum will reach out to the lab weekly for updates on lab approval. Lab approval timeframes vary per lab and may require lab/practice contracting.

Healthie and Optum cannot guarantee lab approval. The timeline and approval depends on the lab vendor, and we cannot expedite this process. The best way to accelerate the approval, is to engage the local laboratory representative in the process. We will work with our customers to communicate any updates received from the lab vendor.

How can I search for Test or ICD10 codes in Optum Clinical Exchange?

The test codes / ICD10 codes may be selected by checking the box to the left of the code if the code icon the preference list for the site. The user may also type the code number in the Test Code/ICD10 code field and hit Enter on your keyboard.

Test and Diagnosis Codes may also be searched for by clicking on the binoculars button to the right of the Code box.

Search in Description, using a wild card. (example *gluc* for any all types of glucose tests or *mellit*for diabetes diagnosis codes).

Once you check the left-hand box for the code, click on “Use Selected” to use that code for this oneorder or click “Use Selected and Save to Preference” to add the code permanently into the preference list. If there are more test code/diagnosis code combinations to add to the order, click the Add To List button and add the next codes.

What if I have both virtual and physical locations?

We can set up a site for both virtual and physical locations. Please consult your lab vendor regarding site location and 3rd party billing requirements.

Will labs be able to be ordered from a patient's chart?

Yes, lab results will automatically be uploaded to a patient's documents but will not be visible to the patient by default. Providers can optionally share the lab results with patients. 

If using insurance, can the patient (and medical clinic) verify insurance upfront?

This is not supported via the Optum Clinical Exchange integration.

If we want a lab to be covered by insurance, do we need to collect insurance information for prior approval, or can a patient take their insurance to the lab?

If a Third Party order (Lab Bills Insurance) is selected, then insurance information will be required during the ordering process.

Can providers save lab preferences? 

Yes, Providers can save individual tests as preferences. Test groups can also be created by Providers via Healthie.

Custom panels are created by the lab (Note: If applicable, labs will provide a test code for each panel.)

How can providers create Preference Lists?

Optum Clinical Exchange allows for frequently ordered tests from a lab to be saved to a Preference List. When the order is created within Optum Clinical Exchange, those preference lists are displayed on the screen so the provider does not have to search for a specific test – they can just check the boxes next to the tests needed. The Clinician preference lists will be updated based on the lab’s latest compendium load. If a test is no longer available from a lab, that test will no longer be displayed in the preference list.

Different test code preference lists can be created at the site level, at the caregiver level, or at the specific client ID level. This allows different providers to have different commonly used tests or a different set of tests associated with a specific client number (for example, a client number used exclusively for micro testing).

Optum Clinical Exchange shows the most specific list defined. If a client ID preference list is defined for the client number, that is the list that will be displayed; if no client ID preference list is defined, it will check to see if there is a provider specific preference list for the doctor placing the order. If no provider specific preference list is defined, it will display the site’s preference list.

To Update Preference Lists - Log into Optum Clinical Exchange. Navigate to Admin > Preference Lists, then choose the list to be created or updated.

When you navigate to Admin > Preference Lists > Test Code, you will see the following:

To create a new list, click Create New Preference List.

Choose the lab and then type in the test codes to be included in the list and click Enter after each. To EDIT an existing test code list, click the underlined lab link, the preference list will open to edit. Once you make the changes, click Save.

To create an ICD10 Code Preference List, navigate to Admin > Preference Lists > ICD10 Code. Click Create New Preference List, do not choose a lab, type in the ICD10 code numbers or description, and click Enter. To EDIT an existing list, click the underlined name and the preference list will open to edit. Make the changes and click Save.

How can providers create Test Groups?

Optum Clinical Exchange also allows for Test Groups to be created to allow ease of ordering. These are groups of tests from a single lab that are frequently ordered at the same time. All of the tests are added to a Test Group with a specific test group code and description defined by the site. When the order is created, the test group is selected and when the order is validated, the test codes default into the individual tests. Optum Clinical Exchange shows the most specific list defined. If a client ID test group is defined for the client number, that is the list that will be displayed; if no client ID Test Group is defined, it will check to see if there is a provider specific Test Group for the doctor placing the order. If no provider specific Test Group is defined, it will display the site’s Test Groups.

To Create a Test Group, navigate to Admin > Tests > Test Group Management.

Click on Create New Test Group. A box will pop up.

Populate the fields for Test Group Name and Description. In the field for Test Codes, type in the test code you wish to add and click Enter. Click Save.

Test Groups can be created as Facility level, Client ID level or Caregiver/Provider level. A Facility level group is displayed across the whole practice. Client ID level groups will show when that client ID is used. Caregiver/Provider level groups will display when that provider is used. A Caregiver/Provider level group will appear instead of a facility level list.

To EDIT an existing test code list, click the underlined lab link, the preference list will open to edit. Once you make the changes, click Save.

How can providers update Test Code and Diagnosis Code Preference Lists from the order screen?

To Update the Test Code Preference Lists from the order screen:

Click on the binoculars button beside the Test Code Search field.

Search for the test by test code or description and check the test to be added to the order. To add it to the test code to the order only, click the “Use Selected” button. To add the test code to the order and the test code preference list, click the “Use Selected & Save to Preferences” button. The Preference List will be updated with the new test code the next time an order is opened.

While a user can add a code to a Preference List, they cannot be removed from the list in the order. The user would need to contact their Vendor Support to have codes removed from the list.

To Update the Diagnosis Code Preference Lists from the order screen:

Click on the binoculars button beside the ICD 10 Code Search field.

Search for the test by diagnosis code or description. Check the code to be added to the order. To add it to the diagnosis code to the order only, click the “Use Selected” button. To add the code to the order and the diagnosis code Preference List, click the “Use Selected & Save to Preferences” button. The Preference List will be updated with the new test code the next time an order is opened.

While a user can add a code to a Preference List, they cannot be removed from the list in the order. The user would need to contact their Vendor Support to have codes removed from the list.

Will a patient need to take an order to the lab facility, or is the electronic send sufficient? 

This will vary by lab company, as patients will need to adhere to the procedures of each specific lab.

Do different labs through the Optum Clinical Exchange have different instructions and how do we know and communicate these instructions? (e.g., walk in vs schedule an appointment)?  

Yes, and patients will need to adhere to the procedures required by each connected lab. Instructions will be provided by the lab facility.

Will the medical clinic be able to track if a patient has gone to the lab? 

Optum does not support this.

Where will lab results go within the Healthie profile? 

Results will go directly to a patient's profile, as well as the Organization Labs page. Healthie will provide data via PDF, HTML and HL7 (depending on what format the laboratory supplies to Healthie). 

Will lab results be available via the API, and will there be a web hook for lab results? 

Providers will receive lab results via the Optum API, directly within Healthie's Labs page. Providers will have the ability to download results as PDFs, but results can also be retrieved as HL7 data via the Healthie API. 

Support for downloading lab results in HL7 format from the UI is planned as a future release. 

Webhooks will be considered for future release, not the initial release of this integration.

How will alert values (e.g., dangerously high or low values) show up in Healthie? 

Lab results data can be provided via HL7. Healthie will not (at least initially) support analysis of lab results or alert value settings.

I'm interested in signing up for a new Labcorp account. Will I have to fill out a questionnaire?

Yes, anyone trying to sign up for a new LCA account WILL have to fill out a questionnaire. In that questionnaire you will be asked "who is your EDI vendor?" You will want to answer "Optum" here.

How is HL7 enabled? Is it automatically on for all customers?

HL7 is specifically referring to the parsing and display of lab results. It is enabled/present for customers who are using Optum Labs, and for labs sending in HL7 data to Healthie.

Who at Healthie can enable HL7?

HL7 is just a part of Optum E-Labs integration, no one at Healthie is currently manually enabling this. Currently, the HL7 data lies on the lab results page, it does not show in Metrics as of this version of the integration, but all the data is available in a discrete fashion.

Are providers notified when lab results are available?

Providers will get an email notification when the results are returned—this is triggered when Healthie receives the HL7 of the results. This email notification is also triggered when Healthie gets the HL7 copy of the order.

Does Optum send out notifications about lab orders?

The Optum Clinical Exchange platform doesn’t send out notifications when we receive results from the lab. Healthie will need to reach out to the labs.

Quest would/could potentially reach out to patients for:

• Reminders on in-home collection tests.
• Reminders there is an order from their Provider waiting for collection at a PSC. (Note: Reminders may not go out for every in-house collection test. It will just depend on the test and how it’s setup on our side.)
• Correspondence to setup up an account w/Quest for billing purposes and/or sending invoices to the patient, if applicable. This will depend on whether or not that business unit is setup to send reminders. (Note: As this is a fairly new process, all business units may not be supported right now.)

Additionally, according to Quest Diagnostics:

• If patient has a balance, we’d send an email to them with a link to setup a Quest account so they can pay their Quest bill online.
• If provider orders a test that requires collection by the patient at home, depending on the test, we can send the patient and email reminding them the test has been ordered and we need them to complete the collection.
• If provider orders a test that requires collection at one of our PSC’s, there can be a reminder sent to the patient telling them there is a pending order with a link to Quest so they can locate the closest PSC to them for collection.

If a user forgets their Optum Labs password, is there a way they can reset it?

Optum allows an admin user the ability to reset passwords for the user, inactivate/reactivate users, and copy users. Navigate to Admin > Account Management > Manage User.

You will see the following options/abilities:

• RESET PASSWORD: Select a user and click RESET PASSWORD
• FORCE LOGOUT: Select a user and click FORCE LOGOUT. Use this if the user is locked out for 3 minutes or if the user is having trouble logging in and she is sure she is using the correct username/password. You can try this before resetting a password.
• INACTIVATE USER: Find a user and place check mark in the INACTIVE box.
• ACTIVATE an INACTIVE USER: At the top of the user list you will see a VIEW: ACTIVE box. Change this to INACTIVE. Find the Inactive user and uncheck the INACTIVE Box.
• ADD NEW USER: Select a current user that you want to copy permissions from then select "Copy User" at the top of the list. A window will open and you will have to fill in all the blue dots. Try to use the first initial of the first name and the full last name as the username. If the name is already used, you will be notified. If the user is created successfully a message will pop up and notify the admin user.

What should I enter for "Code" and what do I enter for "Policy Number"? Would the latter be the Medicare Member ID for a Medicare patient?

Regarding the "Code", this is where you search for the patient's insurance. Click on the Binoculars button to the right of the insurance code field to search.

A Payer Search box will come up. In the Description field, type the name of insurance in the Payer Name (re: medicare*or united* or b*c*b*s* or cigna*). The user is searching for the insurance address that is on the back of the patient's insurance card. Always use an * as a wild card before and after the insurance name. You can also add the city and state from the insurance card address to narrow the search.

Just using an Asterisk (*) will bring up all payers associated with the site. Then click Search.

Click on the select to the right of the correct insurance.

Populate any field that has a blue dot beside it. The Policy Number and the Group number would come from the patient's insurance card. The Group Number is not always required but if it is on the patient's insurance card, it should be added to the order.

If a patient wants to order a lab in a certain zip code, how do they do that?

You can only choose the labs available in the drop down of the lab field. If a lab has been approved for the site, it will be available in the drop down.

For National Accounts for Quest and Labcorp, the PSC order message will go out to all PSC sites across the US for Quest and Labcorp. The patient will need to check the Quest or Labcorp website for the nearest PSC location. For other labs, they can check the lab's website for PSC locations.

Does Optum E-Labs place any restrictions on which states customers operate in?

Will labs ordered directly in Optum/Change Healthcare Clinical Exchange or in a lab's portal return into Healthie?

No. In order for the lab results to return to a client's profile in Healthie, the order needs to have been placed using the Healthie + Optum integration.