Billing Policies for Practitioners
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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.
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 Medicare and Medicare Advantage Plans
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, 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.
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.