Billing Policies for Practitioners
Are You a Patient?
If you're a patient, you may have landed on the wrong page! We have a billing policies page with helpful information specifically prepared for patients. Please use the link below.
Additional insurance information helpful for both patients and practitioners may be found on the Patient Billing Policies page using the button below:
Billing Policies for Practitioners
About Insurance Filing
Diagnostic Solutions Laboratory is not contracted with any commercial insurance company and is considered out-of-network. To determine whether a claim may be covered please have your patient contact their insurance provider. If your patient is concerned that a claim may not be covered, they can choose to prepay for their testing and we will provide them with a statement that they may then submit to their insurance provider for coverage determination. If approved, payment will be made directly to them.
Diagnostic Solutions Laboratory can bill a patient's primary insurance and if needed, their secondary insurance company for testing on their behalf. Based on the test ordered, a deposit is required at the time of test submission (with the exception of traditional Medicare). Claims are submitted to the insurance carrier upon release of the test results. In order to have Diagnostic Solutions Laboratory bill a patient's insurance company, a deposit for services is required. Practitioners should inform patients of the deposit amount required based on the test ordered.
Claims will be submitted at regular list price. Patients will be responsible for any deductible, co-pay, co-insurance, non-covered or disallowed services. If the insurance company does not pay out the total billed by Diagnostic Solutions Laboratory, the patient will be responsible for the remaining amount.
Insurance Claim Requirements
In order for Diagnostic Solutions Laboratory to submit claims to an insurance company, please be sure to fill out the Test Request Form (provided in the collection kit box) completely and include all insurance information. If possible, patients should send in a copy of their insurance cards (front and back). Also, providers must fill out the ICD coding section. Missing information may result in denial of claim/payment.
Deposit payments can be made by check, money order, or major credit card. If your patient chooses to pay the deposit amount by credit card, be sure the card holder signs the authorization on the Test Request Form. Missing information may delay testing.
Please be aware that we are out-of-network with all commercial insurance carriers, but as a courtesy, we will verify and file claims with your patient's insurance carrier; however, we cannot guarantee payment. Patients are responsible for payment of any deductible, co-payment/co-insurance, and any non-covered services.
Many insurance companies have additional stipulations which may affect coverage. Further, insurance companies have different requirements for coverage and may require additional documentation from the ordering provider to justify medical necessity. If the insurance company denies any part of a claim or if providers fail to include information needed to file, payment will be expected from the patient.
Verification is only an explanation of benefits based upon information that we receive from an insurance carrier. It is not a guarantee for payment. Patients should contact their insurance carrier directly to confirm individual benefits for out-of-network testing services.
If Patients Have Traditional Medicare
Diagnostic Solutions Laboratory is a participating provider for Medicare. In order to submit claims to Medicare be sure to check the Medicare billing option on the Test Request Form. Patients should provide their Medicare information in the Primary Insurance section. If your patient has a Medicare supplement policy, they must include the insurance information in the Secondary Insurance section of the Test Request Form.
Please note that Medicare will only accept claims ordered by Medicare participating providers, which are PECOS certified. In most cases Medicare will only process claims ordered by the following clinicians, MD, DO, PA and NP.
Medicare Advantage/Replacement plans are treated as commercial insurances. We are not contracted with most Medicare Advantage/Replacement Plans.
- Please call our Customer Service Line at 877-485-5336 to find out if we are able to file a claim to your Medicare Advantage/Replacement plan. If we are able to file a claim, please be sure to fill out the Test Request Form completely and include all insurance information (include copy of insurance cards front and back). Also, be sure that your provider has completed the ICD10 coding section.
- Missing information may result in denial of claim/payment. Please be aware that Medicare Advantage Patients without out of Network benefits will be responsible for the discounted cash rate.
Medicare Advantage/Replacement plans are treated as commercial insurances, please follow Insurance Filing instructions. In order for Diagnostic Solutions Laboratory to submit claims on your patient's behalf, please be sure to fill out the Test Request Form completely and have your patient include all insurance information (including a copy of their insurance cards). Also, practitioners must complete the ICD coding section. Missing information may result in the denial of claim/payment. Please be aware that Medicare Advantage patients without out-of-network benefits will be responsible for the full discounted cash rate.
Additional Insurance Information
Our patients are the center of everything we do. Your trust is very important to us and sharing information is one way to help ensure we continue to earn this trust.
Medicare Advantage plans are commercial insurance plans and are not the same as traditional Medicare.
Medicare Advantage plans are managed by commercial insurance companies on behalf of Medicare and offer a specific network of contracted labs, which may not include Diagnostic Solutions Laboratory. We are considered out of network with all commercial insurances.
We do accept original Medicare and supplement plans, sometimes referred to as Traditional Medicare.
Diagnostic Solutions Laboratory is out-of-network and is not contracted with any insurance plan. Therefore, we are unable to file with insurance plans which do not sufficiently cover out-of-network services. Your benefit coverage is determined solely by your insurance company and is based on the provisions of your specific medical benefit plan.
The following information is updated periodically and is subject to change. This list is not meant to be all-inclusive. Please check with your health plan to verify coverage.
Plans Diagnostic Solutions Laboratory Will File With
- Most PPO insurance plans
- Traditional Medicare
You may also contact our customer service directly for more details about insurance coverage at 877-485-5336, or via email at firstname.lastname@example.org.
Commercial Plans (unable to file)
Diagnostic Solutions Laboratory Is Unable to File With Commercial Plans Listed Below
- Blue Cross & Blue Shield of MN (Provider must be registered with them)
- Blue Cross and Blue Shield of Hawaii HMSA
- Blue Cross and Blue Shield of SC
- Blue Cross Blue Shield of AZ
- Blue Cross Blue Shield of D.C.
- Blue Cross Blue Shield of Kansas City
- Blue Cross Blue Shield of LA
- Blue Cross Blue Shield of Maryland Carefirst
- Blue Cross Blue Shield of MI
- Blue Cross Blue Shield of MT
- Blue Cross Blue Shield of NC
- Blue Cross Blue Shield of NE
- Blue Cross Blue Shield of NJ
- Blue Cross Blue Shield of OK
- Blue Cross Blue Shield of OR Regence
- Blue Cross Blue Shield of PA (Highmark, Independence & Capitol Blue)
- Blue Cross Blue Shield of TX
- Blue Cross Blue Shield of UT
- Blue Cross Blue Shield of VT
- Blue Cross Blue Shield of Wellmark IA
- Blue Cross Blue Shield of WI
- Blue Shield of WA Regence
- Carefirst Administrators
- Christian Healthcare Ministries
- Community Insurance Company – Blue Cross Blue Shield of OH
- Delta Health Systems
- Federal Blue of GA
- Harvard Pilgrim
- Health Net CA
- Home Town Health
- Kaiser of California
- Liberty Health Share
- Medi Share
- Medicare Advantage/Replacement Plans
- Medicare Secondary
- Presbyterian Health Plan
- Rocky Mountain Hospital
- Select Health
- Summa Health Network
- Total Health Care
- Total Health Plan Inc.
- Tufts Health Plan
- United Health Care
- US Family Health Plan (USFHP)
Upon payment, Diagnostic Solutions Laboratory will provide an itemized receipt by request if we cannot file with your insurance. This receipt can be turned into your insurance for reimbursement. (Not applicable for Medicare Advantage/Replacement Plans)
Uninsured (Self-Pay) Or Underinsured Patients
You may be considered underinsured if you have a:
- High deductible
- High out-of-pocket maximum requirement
- Limited benefit plan(s)
Diagnostic Solutions Laboratory will provide an itemized receipt by request if we cannot file with your insurance. This receipt can be turned into your insurance for reimbursement.
Diagnostic Solutions Laboratory is noncontracted with any insurance plans: Many insurance companies do not agree to Diagnostic Solutions Laboratory rates — patients will have a greater out-of-pocket expense as the coverage amount allowed by your insurance plan can differ from our rates. You will be responsible for the difference.
Uninsured (Self-Pay) Discount
Please contact our Customer Service to find out about Diagnostic Solutions Laboratory Uninsured Discount Policy. Call 877-485-5336 or email email@example.com. Diagnostic Solutions Laboratory offers discounted prices to all qualified uninsured patients for medically necessary care.
Insurance claims may be denied for many reasons. If your Diagnostic Solutions Laboratory claim has been denied, a good first step is to consult the list below for suggestions on the next steps toward resolving your claim.
- The benefits maximum for this period has been reached – Some insurance companies limit the dollar amount they will pay per year for certain services, or they limit the number of services eligible for coverage per year. If your statement shows that you have a balance due because you exceeded your benefit limit, it is because this is the information we received from your insurance company. They are stating that they have paid up to the maximum limit they provide coverage for and that the patient is responsible for the remaining balance. Unfortunately, because we are not aware of other claims your insurance is processing for you, we can never be aware of exactly how much of your benefit limit has been reached until our claim processes. If you are disputing this, we recommend calling your insurance company so they can tell you the details of why your benefit limit has been reached/exceeded.
- Charges exceed your contracted fee schedule – Charges exceed the fee schedule/maximum allowable or contracted/legislated fee arrangement. Denial code is denoted on the EOB/ERA from an insurance company when the insurance plan contractually allowed amount is lesser than laboratory billed charges.
- Claim or service lacks information for payment processing – Your insurer wants to see medical records or EOB. (We do not have access to your medical records. This may require you to reach out to your provider to request the relevant information).
- Insufficient or incomplete requested information – Your insurer wants to see medical records or EOB. (We do not have access to your medical records. This may require you to reach out to your provider to request the relevant information).
- Non-covered services or diagnosis codes (ICD10) – Your insurance plan does not cover the particular test, or your provider did not use a diagnosis code that deems the test medically necessary.
- Not medically necessary – Your insurance plan does not deem the particular test as medically necessary, or your provider did not use a diagnosis code that deems the test medically necessary.
- Service deemed experimental/investigational or not proven to be effective
Benefit coverage for laboratory testing provided by Diagnostic Solutions Laboratory is determined solely by the insurance company and is based on the provisions of the specific medical benefit plan.
Please contact the customer service department on the back of the member identification card to confirm out-of-network access to Diagnostic Solutions Laboratory testing, as well as benefit level.
In most cases, Diagnostic Solutions Laboratory will appeal after a denial, which may or may not be successful. You may also wish to check with your insurance provider and review some general hints on insurance appeals.
Diagnostic Solutions Laboratory will file claims to commercial insurance plans with out-of-network coverage (including Medicare Advantage Plans).
Our process to assure the lowest out-of-pocket cost is as follows:
- Patient submits the required initial deposit with the specimen.
- Once test results are complete, Diagnostic Solutions Laboratory will file the claim with the patient's insurance company.
- Once the insurance company has processed the claim, they will mail the patient an Explanation of Benefits indicating how much of the claim they have paid. If the insurance company does not pay a claim in full, Diagnostic Solutions Laboratory will send patients a billing statement with the amount due stated under patient responsibility.
- Payment is due by the date indicated on the statement, as applicable discounts are time sensitive and will expire.
In some instances, commercial insurance plans may send the payment of the claim directly to the patient. If so, it is the patient's responsibility to forward the payment directly to Diagnostic Solutions Laboratory.
Please see information at top of the page to learn about our insurance billing policies.
Cash Pay (No Insurance Billing)
This option is for patients who do not have insurance or choose not to have Diagnostic Solutions Laboratory submit a claim to their insurance company. Payment is due with the submission of the test.
This option is for providers who want to pay for testing directly. Practitioners are required to put a credit card on file with us. The credit card will be charged one to two business days after their patient's sample is received by the lab. A detailed billing statement is provided at closing of each billing cycle. Please contact our billing office at 877-485-5336 to put a credit card on file with us.
Please note this option is not available to providers located in NY, NJ, and RI due to state-imposed limitations.
Medicare (Not Applicable to Medicare Advantage Plans)
As stated above, please make sure practitioner is PECOS certified and is a qualifying degree type (MD, DO, PA and NP).
Diagnostic Solutions will file claims to Medicare (and Tricare) plans.
Important Information about Filing Medicare Claims
The following conditions must be met in order for Diagnostic Solutions Laboratory to file claims directly to Medicare:
- The test ordered is deemed medically necessary.
- The provider has a degree type that meets Medicare's qualifications to refer Medicare patients.
- The provider is PECOS certified.
- The order for testing was completed, signed by the ordering provider, and includes valid ICD-10 diagnosis codes.
Who is Authorized to Order?
Medicare only allows healthcare practitioners with certain credentials to order and refer services for Medicare patients. See degree types below that are commonly considered PECOS certified.
What is PECOS?
PECOS stands for Provider, Enrollment, Chain, and Ownership System. It is the online Medicare enrollment management system that allows individuals and entities to enroll as Medicare providers or suppliers. Only practitioners that are enrolled in PECOS can order testing that is to be billed to Medicare. Check PECOS status here. (Opens in new window.)
Medicare and other insurance programs require a physician signature to validate orders for laboratory services. Signatures may be either electronic or handwritten, must be legible, and must be dated.
Practitioners who wish to keep their signature on file with Diagnostic Solutions Laboratory can complete our Electronic Signature Authorization Form.
Using the Electronic Signature Form
An authorized signature by a qualifying practitioner is required in order for a test to be processed. If you fill out the Electronic Signature Authorization Form and return it to us, we'll keep your signature on file and use it when you order testing for your patients.
Access and download the form below (PDF opens in a new window).
Questions About Your Bill?
Please call us at 877-485-5336 if you have questions about your bill. Medical billing can be complex, especially when insurance is involved. We are here to help!
Canceling or Changing Ordered Testing
Canceling or changing any ordered testing must be done by the ordering provider — before results are reported. Once results have been reported, charges for the ordered test will occur.