-
If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten your username or password use our password reminder tool. To start viewing messages, select the forum that you want to visit from the selection below..
Wiki Horizon BCBS NJX reimbursement for out of network laboratory services
- Thread starter nataliiam
- Start date
andersona1229
Networker
Fellow independent lab biller here. To put it bluntly, you've got to eat the denial and follow the EOB. If it's an adjustment, then you adjust. Full balance to patient responsibility, bill the patient. Patients can appeal these denials if they didn't know their specimen was being sent to an OON lab and the ordering provider is in-network. We deal with this frequently as we're OON with some plans in high volume states for us so we have to bite the bullet on it.
Pray they don't start sending the checks & EOBs to the patients; I can't tell you how many patients call in about their bill and find out those checks from Anthem were for their lab work and not for personal use.
Pray they don't start sending the checks & EOBs to the patients; I can't tell you how many patients call in about their bill and find out those checks from Anthem were for their lab work and not for personal use.
SMatsu
Guest
@nataliiam or @andersona1229 - I also work for an independent lab and am worried we’re billing claims incorrectly. Would either of you be willing to share your expertise/insight via this thread or private conversation?
We receive biopsies from neurologists all over the US. Patients are not seen in our lab.
Questions:
Do you use the DN or DK modifier. We use DN and I can’t figure out why
Whose information are you putting in Box 32? We put our billing address and group NPI in both Box 32 and 33 and I don’t believe that’s correct.
POS: Do you ever bill POS 11 on your claims?
Thank you for any information you’re willing to provide!
We receive biopsies from neurologists all over the US. Patients are not seen in our lab.
Questions:
Do you use the DN or DK modifier. We use DN and I can’t figure out why
Whose information are you putting in Box 32? We put our billing address and group NPI in both Box 32 and 33 and I don’t believe that’s correct.
POS: Do you ever bill POS 11 on your claims?
Thank you for any information you’re willing to provide!
andersona1229
Networker
I’m so sorry I missed this! You can PM me and we can work this out.
