Nov. 11, 2024
To help ensure that claims are processed efficiently and accurately, follow billing guidelines for independent clinical laboratory claims. Information on ancillary claim submissions is in the commercial provider manual.
Tips on submitting laboratory claims: Submit laboratory claims for members of Blue Cross and Blue Shield plans through the plan state where samples were collected.
Maintain valid laboratory medical records. Records should be complete, legible and include the following information:
- A signed valid requisition received from the physician or qualified health care provider who is treating the patient and will use the results in the management of the patient’s specific medical problem
- Documentation of the services ordered
- Results of the services performed
More information
- See medical policy and clinical payment and coding policies
- Check eligibility and benefits prior to rendering services
- Call the number on the member ID card for individual benefit and coverage information
- Refer to the commercial provider manual or the BlueCard® program provider manual on standards and requirements
- Review the education and reference center regularly for resources, learning materials and interactive tools to ensure billing is in compliance
On March 7, 2024, we posted these guidelines on News and Updates.
The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.