Wiki Lab billing

[mandriap]

The physician is drawing the labs in house and sending to an outside laboratory. The physician is billing the patients insurance for the labs and the outside laboratory bills the provider. My question is do you bill with the providers CLIA# or the labs CLIA#? when we bill with the providers we get rejections stating the provider does not meet the certification level. When we bill with the lab # then we get rejection stating the address doesn't match the clia# of course. We are billing with the 90 modifier but is there something else we should be doing? TIA

 

[mmsllc73]

Hello, I'm not sure if you received an answer to your question, but if I understand it correctly, this is what our office does..... we collect the specimen and just bill the venipuncture code when we send our labs to an outside laboratory. I don't believe the provider and the laboratory can bill the same codes; we did bill the labs in-house in error, as well as the laboratory, and the claims were denied for other provider-rendered services. My issue is that we have several locations where our providers see patients, and we will collect the specimen in-house, and the specimen is sent to another location to be processed, which is still part of our group, which is technically our lab facility. Each facility has its own CLIA #, but the one location is where the labs are truly processed, so on the billing, we have the CLIA # associated with where the labs are being processed, but now we are getting rejections stating the zip code does not match the registered CLIA #.
Do you know if this is incorrect? Or should we bill separate claims with the location where the labs are processing and not where the labs were drawn? Any guidance is truly appreciated.