Carrier Claims Processing - Jurisdiction of Laboratory Claims (Rev. 3071, 12-22-14)

by  Jared Staheli
July 10th, 2015

Jurisdiction of payment requests for laboratory services furnished by an independent laboratory, except where indicated in §50.5.1 and §50.5.2, lies with the B MAC serving the area in which the laboratory test is performed. Jurisdiction is not affected by whether or not the independent laboratory uses a central billing office and whether or not the laboratory provides services to customers outside its carrier’s service area. The location where the independent laboratory performed the test determines the appropriate billing jurisdiction. Therefore, even if the sample originates in a different jurisdiction from where the sample is being tested, the claim would still be filed in the jurisdiction where the test was performed. Claims filing jurisdiction for the specimen collection fee and travel allowance is also determined by the location where the test was performed.

When billed by an independent lab, the specimen collection fee and travel allowance must be billed in conjunction with a covered lab test. For more information about the specimen collection fee and travel allowance, see §60.1 and §60.2, respectively.

References:

Carrier Claims Processing - Jurisdiction of Laboratory Claims (Rev. 3071, 12-22-14). (2015, July 10). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/carrier-claims-processing-jurisdiction-of-laboratory-claims-rev-3071-12-22-14-27204.html

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