Bio-Reference Laboratories Submits Claims To The Following List Of Insurance Companies.

Bio-Reference Has A Contractual Agreement with Those Marked with a “C”

Contractual agreements are defined as those plans which Bio-Reference Laboratories currently has a contract to accept insurance companies’ reimbursement fee amount as payment in full. However, depending on the plan there may be deductibles, co-pays and other subscriber defined responsibilities that are required by law to bill the patient.

For insurance’s not on this list Bio-Reference will bill the patient and provide a 1500 form for their convenience upon request.

1199 National Benefit Fund “C”
1199 Home Care “C”
32 BJ Health Fund “C”
AARP
ABC Health Plan “C”
ADAP “C”
Administrative Concepts “C”
AETNA “C” (all but HMO non-fertility)
AFTRA “C”
AGA/American Group Administrators
AIG/American International Group “C”
Alicare
Alliance
Allied International Union
Allmerica Financial “C”
Alta Health “C”
Amalgamated Life/ACTWU
Americaid “C”
American Choice Health
American Health
American Maritime Officers/PHCS “C”
American Postal Worker Union
Americhoice NY/NJ/PA “C”
Amerihealth “C”
Anheuser Busch
Anthem Health/Life “C”
APWU
Atlantic Planning Consultants
Atlantis Health Plan “C”
AUSA Life Ins./Magnacare “C”
Bakery Confectionery & Tobacco
Bankers Life & Casuality/PHCS “C”
BCBS of Central NY “C”
BCBS of NJ/Horizon “C” (Not HMO)
BCBS of NY Western “C”
BCBS of Rochester “C”
BCBS of Utica/Watertown NY “C”
BCBS ALL OTHER STATES
Beechstreet “C”
Bell Atlantic
Benefit Concepts “C”
Benefit Plan Administrators/BPA
Benesight
Board of Pension/PHCS “C”
Boilermakers NTL Welfare Fund
Bollinger
Bricklayers Fringe Benefit
Capital District Physicians
Carefirst Administrators “C”
Careplus “C”
Carpenters Welfare NJ
Center Care “C”
Central Reserve Life/PHCS “C”
Central States Hlth Welf/PHCS “C”
Champus “C”
Chesterfield Resources
Chickering
CHN/Consumer Health Network “C”
CHP
CIGNA “C”
Claims Management Service
Connecticut General/CIGNA “C”
Continental Assurance/PHCS “C”
Coresource/PHCS “C”
Corporate Health Administrators
CUNA Mutual/PHCS “C”
DCI Insurance Department
Directors Guild of America/PHCS “C”
Diversified Administration
Eastern Benefit System
EBA &M
Employer Health/PHCS “C”
EPC Associates
Equitable/CIGNA
Evolutions Health Care Systems “C”
Excellus/BCBS “C”
Federal Employee BCBS “C”
Fidelis Corporate Claims
First Health “C”
Fortis Benefits/PHCS “C”
Galaxy Health Network “C”
Gallagher
Gallagher Bassett
Gallagher Benefit
General American/PHCS “C”
Genesis
Golden Rule
Government Employees Hosp.Asso/GEHA“C”
Great American/PHCS “C”
Great West/PHCS “C”
Guardian Life Insurance
HCPC/Health Care Payors Coalition “C”
Health Administrators
Health Care Compare/First Health “C”
Health Choice Inc.
Health Manager
Health Options “C”
Health Partners PA “C”
Health Plus “C”
Health Source “C”
HIP
HMO-CNY “C”
Home Care Industries
Horizon Healthcare Administration
HRM Claim Management
Humana/PHCS “C”
IAM District 15/ Machinists
IDA/Insurance Design Administration “C”
INDECS “C”
Independent Processing
International Benefit Administration
International Union
Jefferson Pilot/PHCS “C”
John Alden/PHCS “C”
John Deere/PHCS “C”
John Hancock/Unicare
Kaiser Permanente
Kidcare/NJ Family Care “C”
Liberty Mutual
Life Benefit Plan
Life Investors/PHCS “C”
Local 1 D/Wine & Liquor Distillery
Local 100/NY Bus Service
Local 1010/Pavers & Road Builders
Local 107/PACE
Local 108/Retail/Wholesale
Local 1102/AFL CIO
Local 1115
Local 1199 “C”
Local 1430/Electrical Workers
Local 144/Nursing Home/HCPC “C”
Local 144/1199 Members Choice
Local 1478 2/Intrnl Long Shoremen
Local 15/15A/15C/15D/AFL CIO “C”
Local 164/Electrical Workers
Local 1718/ United Production Workers “C”
Local 172/472/ Heavy General
Local 1730/ Long Shoremen
Local 1964/ ILA
Local 20/Cement Concrete
Local 210/Maxon
Local 22/ Sheet Metal
Local 25/ Sheet Metal Workers
Local 259/ Social Security Dept.
Local 2682/Union Security Trust Fund
Local 274/ Welfare Fund “C”
Local 284/ Laundry Workers
Local 2947/ Hollow Metal Trust
Local 3/ Bakery & Confectionery
Local 3/ IBEW “C”
Local 30/ Engineers
Local 338/ Pension & Welfare
Local 338/ RWDSU/Multiplan “C”
MVP
National Assoc of Letter Carriers/NALC
National Automatic Sprinklers/PHCS “C”
National Benefit Administration “C”
National Elevator/PHCS “C”
National Employee Benefit
National Health Plan “C”
National Organization of Industry
Nationwide/PHCS “C”Local 340/ Barneys Retail
Local 342/ Union Labor Life Ins.
Local 342 / Seafood Welfare Fund
Local 348/United Foods Commer Workers
Local 363/ IBEW Electrical
Local 365/ Cemetery Workers
Local 365 UAW
Local 377/ Welfare Fund
Local 389/ Allied Welfare Fund “C”
Local 469/ Hotel Restaurant Workers
Local 456/ Allied Benefit Funds
Local 464A/United Food/UFCW “C”
Local 469/Benefit Teamsters Fund
Local 472 & 172/Heavy General
Local 475/Steamfitters
Local 485/Machine Workers
Local 50/Maloney Assoc. “C”
Local 54/Theater Workers
Local 584/Milk Truck Drivers
Local 6/Hotel Rest./Club Employees
Local 60/WestChester Heavy Construc “C”
Local 670/Welfare Fund
Local 715/NJ Carpenters
Local 731/Excavators “C”
Local 734 /Laborers “C”
Local 74/SEIU
Local 76B/Furniture Workers
Local 805/Allied Welfare Fund “C”
Local 806/Health Welfare Fund “C”
Local 806/Bridge Service “C”
Local 807/Teamsters Truck Union “C”
Local 812/GIPA Health Fund “C”
Local 814/Teamsters
Local 821/Carpenters Specialty
Local 825/Operating Engineers “C”
Local 840/International Brotherhood Teams
Local 854/Bus & Truck Drivers & Lab Techs.
Local 863/Fruit and Vegetables
Local 91/ United Crafts “C”
Local 917/Drivers Teamsters Union
Local 918/United Teamsters Funds “C”
Local 94/94A/ Operating Engineers
Local 966/IE Shaffer
Local 97/ Teamsters
Magnacare “C” (All)
Mail Handlers Benefit Plan “C”
Marcal Healthcare Plan
Mastercare “C”
Medicare “C”
Medichoice “C”
Mediplan
Mediprime
Mega Life/PHCS “C”
Metlife “C”
Metrahealth “C”
Metropolitian Life Ins/Metlife “C”
Multiplan “C” (All)
Neighborhood Health Providers “C”
New England Financial/PHCS “C”
Nippon Life Insurance “C”
NJ Medicaid “C”
NMU Pension & Welfare Plan
NOITU Insurance Trust Fund
North American Administrators
NYS Automobile Dealers
NY State Employees/United Health Care “C”
One Health Plan “C’
Optima
Optimum Choice
Orange Ulster/Medichoice “C”
PA Medicaid
Pacific Mutual PHCS “C”
Painting Industry Insurance
Performax
PHCS “C” (All)
Phoenix Group/PHCS “C”
PM Group Benefits/PHCS “C”
Pointers Cleaners Caulkers
Pomco “C”
Precise Benefits
Principle Financial “C”
Principal Insurance “C”
Private Health Care Systems/PHCS “C”
Producers/SAG/PHCS “C”
Prudential
Prunet
Publishers Newspaper
Qualcare “C”
Railroad Medicare “C”
Reliastar/PHCS “C”
Reliastar Northwestern National/PHCS “C”
RMSCO “C”
SAG/Actors/Producer Guild/PHCS “C”
Sagamore Health Network “C”
Seabury & Smith
Select Pro “C”
Select Provid./USI Administrators “C”
Shaffer IE
Sieba “C”
Solidarity of Labor/Solo “C”
Southwestern Bell
St. Barnabas
Storeworkers Security Plan “C”
Strawberry Associates
Summit Health/CHN
Total Plan Administration Plan 2000
Travelers CGT
Tricare “C”
Trustmark/PHCS “C”
UFCW Intern. Union/Amalgamated “C”
ULLICO/Union Labor Life
UMWA
Unicare “C”
Union Security Trust Fund Mutual of Omaha
UNISYS “C”
United
United Healthcare “C”
United Medical Resources “C”
United Mine Worker of America
Univera Health “C”
University Health Plan “C”
US Alliance “C”
US Healthcare “C” (all but HMO non-fertility)
US Life
USI Administrators “C”
Value Behavioral Health
VYTRA
WAUSAU Benefits “C”
Willis Corroon
Writers Guild/PHCS “C”

Direct Billing To The Patient

Bio-Reference will bill your patients directly for our services. The patients full name, street address including apartment number, city, state and zip code must be clearly printed in the space provided on the requisition (including Social Security Number). A complete address at the time the test is ordered is essential. Each requisition will result in a separate bill to the patient. Payment of patient bills is due upon receipt and, if not paid, will be followed by subsequent reminders and normal collection activity.

Direct Billing To Third Party
For patients who are subscribers or recipients of benefits from one of the agencies listed on page XX, Bio-Reference will bill the patient directly for services not covered by their contract or program, for any amount that has been applied towards a deductible, and for any balance due after payment up to the terms of their specific contract. Payment is due upon receipt, and if not paid, will be followed by subsequent reminders and normal collection activities. Please be certain to include all necessary information in the space provided on the requisition at the time the test is ordered. Complete information avoids the need to interrupt and impose upon your staff or patients with requests for information not initially provided.

Medicare

Please be sure to complete the Medicare requisition for any of your patients who are eligible for Medicare coverage.

In order to bill Medicare, we require the following information. If you have any questions, please feel free to call us.

1. Patient Name
2. Patient Address (Including Zip code)
3. Patient Sex
4. Patient Medicare (HIC) Usually, but not limited to # 9 numerics plus 1 or 2 alpha/numeric suffix).

5. Medicare currently requires that you provide an appropriate diagnosis code for specific laboratory tests (please refer to page XX).
6. Referring Physician Name and UPIN Number (1 alpha 5 numerics)

Medicaid

Please be sure to complete the Medicaid requisition for any of your patients who are eligible for Medicaid coverage.

In order to bill Medicaid, we require the following information. If you have any questions, please feel free to call us.

1. Patient Name
2. Patient Date of Birth
3. Patient Sex
4. Medicaid ID # (10 numerics plus 2 numerics/person # suffix)

7. Diagnosis Code
8. Referring Physician Name and Medicaid (IMP#) Provider Number (7 numerics)
9. Physician Signature

Other Third Party Payors

1. Patient Name
2. Patient Address
3. Patient Date of Birth
4. Patient Sex
5. Subscriber Name and Date of Birth
6. Patient’s Relationship to Subscriber

7. ID # plus Group Number
8. Insurance Company (Third Party Payor) Name and Complete Address
9. Diagnosis Code
10. Referring Physician’s Full Name

NOTICE

Bio-Reference Laboratories, Inc. has a fiduciary responsibility to remind physicians that when they order tests in which Medicare/Medicaid reimbursement will be sought, physicians should only order tests that are “medically necessary.” This means that only tests which are required for the diagnosis or treatment of a patient can be ordered for tests reimbursed by Medicare/Medicaid. This government policy eliminates most testing for screening purposes only. Exceptions and Requirements are noted on following pages.

Medicare Patients Must Pay For Tests Ordered Outside Utilization Guidelines

Utilization parameters have been developed based on comments received from Medicare’s Carrier Advisory Committees and Professional Consultants for laboratory tests. The parameters represent the normal utilization of the test. Medicare recognizes that some clinical conditions may require testing at a frequency which exceeds these guidelines. Likewise, providers may find testing at lower frequencies to be appropriate. Claims submitted for services which exceed these guidelines require additional documentation before payment is made.

Glycated Hemoglobin (83036) 1 every 3 months,
except 1 per month during pregnancy
Lipid Panel (80061, 82465, 83718) 1 every 4 months
Screening Pap Smear (G0123, P3000, P3001) 1 every 2 years
Prostate Cancer Screening Test (G0103) 1 every 12 months

When ordering any of the tests above outside of their corresponding utilization guidelines and without additional documentation, please have the patient sign the Patient Waiver Section of the requisition form, so they may be billed directly for the test.

Procedures Of Questionable Current Usefulness

The following tests are considered "Procedures of Questionable Current Usefulness" by Medicare and require documentation which satisfactorily establishes the procedure's medical necessity (letter of medical necessity). The reference is Medicare Medical Policy Bulletin No. G-33. If a letter of medical necessity can not be provided, please have the patient sign the Patient Waiver section of the requisition form, so they may be billed directly for the test.

LAB TEST
CODE DESCRIPTION CPT CODE

1232-8 17-HYDROXYPREGNENOLONE 84143
1613-9 3-ALPHA ANDROSTANEDICOL-G 82154
0427-5 ARSENIC 24 HR. URINE 82175
0845-8 ARSENIC BLOOD 82175
1447-2 ATRIAL NATRIURETIC FACTOR (ANF) 83880
1310-2 BETA ENDORPHIN 84999
1596-6 CORTICOTROPIN RELEASING HORMONE 84999
2426-5 ENDOTHELIN-I 84999
1428-2 FELBAMATE 80299
1179-1 FIBRONECTIN AGGREGATES, IGG 84999
1903-4 FOSCARNET, SUSCEPTIBILITY 87999
0111-5 HEXOSAMINIDASE A (TAY SACHS) 84999
1866-3 HYDROXYCORTISOL 18 84999
1316-9 IGF-BP3 84999
2474-5 INSULIN-LIKE GROWTH FACTOR II 84999
1104-9 INTERLEUKIN-1b (IL-1b) 84999
1026-4 INTERLEUKIN-6 (IL-6) 84999
0443-2 KETOSTEROIDS 17-, (17-KS) TOTAL 83586
0398-8 LEAD, BLOOD 83655
2475-2 LAL (LIMULUS AMEBOCYTE LYSATE) 87999
0808-6 LEAD, URINE (24 HR.) 83655
0804-5 LEUCINE AMINOPEITIDASE, SERUM 83670
0631-2 MELANO. STIM. HORMONE (GAMMA) 84999
0635-3 MELANO. STIM. HORMONE (BETA) 84999
0632-0 MELANO. STIM. HORMONE (ALPHA) 84999
1270-8 METHYLDOPA (ALDOMET) 80299
0909-2 MHPG, 24HR. URINE 84999
2192-3 MYELOPEROXIDASE Ab. 84999
1419-1 NATURAL KILELR CELL FUNCTION 86849
2154-3 NEURONTIN (GABAPENTIN), SERUM 80299
1368-0 NITROGLYCERINE 80299
1947-1 NORRISE DISEASE TESTING 86849
1594-1 PEPSINOGEN, SERUM 80101
0963-9 PROPOXYPHENE, URINE, QUAL. 80099
0232-9 SELENIUM, SERUM 84255
2078-4 SILVER LEVEL, 24 hr. 82190
1716-0 SULFATIDE ANTIBODY, IGM 84999
0415-0 THIOTHIXENE, PLASMA 80299
2127-9 THYROTROPIN RELEASING HORMONE 84999
1266-6 TOCAINIDE LEVEL 80299
2098-2 TRYPSINOGEN, SERUM 84999
2148-5 TRYPTASE, SERUM 84999

Experimental Investigational Tests

These tests are considered experimental/investigational by Medicare. Services performed in connection with research or experimental studies are excluded from payment and therefore require that the patients sign the Patient Waiver Section of the requisition form. The following CPT codes were acquired from the Medicare Reference Manual, Chapter 6 : 82523, 85337, 86343, 86602, 86619, 86682, 86717, 86723, 86732, 86741, 86750, 86753, 86768, 86771, 86774, 88358, 88371, and 88372.

LAB
TEST CODE DESCRIPTION CPT CODE

1143-7 AMOEBA ANTIBODY PANEL (ID/IHA) 86753
5585-5 DNA PLOIDY (IMAGE ANALYSIS) 88358
1752-5 LISTERIA AB IGG 86723
1636-0 SALMONELLA ANTIBODIES (G/A/M) 80099
0974-6 TETANUS ANTITOXIN ASSAY, SERUM 86774
0460-6 TYPHUS FEVER ANTIBODY 80099

NON-COVERED TESTS

These tests are considered "non-covered services" and will not be paid for by Medicare. These tests DO NOT require that the patients sign the Patient Waiver Section of the requisition form, they are:
LAB
TEST CODE
DESCRIPTION NON-COVERED
CPT
0689-0 CHLAMYDIA AG. IMMUNO.(GENITAL) 87320
0726-0 CHLAMYDIA AG. IMMUNO.(URINE) 87491
1410-0 INFLUENZA Ab. TYPES A/B 87301
1719-4 LYME AG URINE 87476
0946-4 PARA-INFLUENZA Ab. 80099
0133-9 PREGNANCY URINE 81025
0643-7 URINE VOLUME (TIMED PERIOD) 81050
1639-4 LIPOPROTEIN (Lp-a) 82172
3547-7 OXCARBAZEPINE 82491
3553-5 CONGESTIVE HEART BNP DETECTR 83880
1374-8 VITAMIN K-1 84597
3530-3 STRONGYLOIDES IGG, AB. 86682
1185-8 TOXOCARA IGG ANTIBODIES 86682
1752-5 LISTERIA MONOCYTOGNES IGG AB. 86723
3118-7 IMM/NON-IMM MUMPS IGG AB 86735
0316-0 MUMPS VIRUS AB. (IGG) 86735
1151-0 MUMPS VIRUS TITER (IGM) 86735

As these change frequently, it is best to check with Medicare if there is a doubt regarding the coverage.
Medicare has instituted certain changes with regard to the processing of laboratory claims for Medicare patients that affect both the laboratory and the physician. Most of you are aware that if an appropriate diagnosis code does not accompany a Medicare claim, the claim will be rejected.

The Medicare Special Notice, dated April 23, 1996, states specifically that:

“A provider, by virtue of furnishing a laboratory service to a Medicare beneficiary, is responsible for making a judgment as to whether the service is medically necessary and for informing the beneficiary in writing prior to furnishing the service, of the likelihood of Medicare denial of payment on the basis that the service is not reasonable and necessary. If the provider fails to verify the medical necessity of ordered tests, and the tests are subsequently determined not to be medically necessary, the provider may be held liable for payment unless the beneficiary received advanced notice of the likelihood of the denial.”

Therefore, if the physician does not provide an Appropriate Diagnosis Code for the aforementioned tests listed above, then Medicare will not pay for the test. In order to make the patient responsible for the payment of a test, their written consent must be obtained prior to performing the test. The recommendation of Medicare is that the laboratory should not run the specimen unless it has an appropriate diagnosis code or a patient waiver accepting responsibility for payment of the test. If the physician does not obtain the waiver, then the laboratory, according to Medicare, should contact the patient directly prior to performing the test to obtain a waiver.

Under the U.S. fiscal year 1988 Budget Reconciliation package Congress has approved that beginning January 1, 1998, physicians must provide diagnostic information at the time a laboratory test is ordered. Therefore, it is Bio-Reference’s policy to require diagnosis codes on all requisition forms.

Please remember, the Federal Government has mandated that physicians should only order tests that are medically necessary for the diagnosis and treatment of a patient.

Disease Specific Profiles
Approved for Government Health Plans

CODE PROFILE

2555-1 Basic Metabolic Panel
Calcium (82310)
Carbon dioxide (82374)
Chloride (82435)
Creatinine (82565)
Glucose (82947)
Potassium (84132)
Sodium (84295)
Urea Nitrogen (BUN) (84520)

3427-2 Comprehensive Metabolic Panel
Albumin (82040)
Bilirubin, total (82247)
Calcium (82310)
Carbon dioxide (bicarbonate) (82374)
Chloride (82435)
Creatinine (82565)
Glucose (82947)
Phosphatase, alkaline (84075)
Potassium (84132)
Protein, total (84155)
Sodium (84295)
Transferase, alanine amino (ALT) (SGPT) (84460)
Transferase, aspartate amino (AST) (SGOT) (84450)
Urea Nitrogen (BUN) (84520)

3284-7 Renal Function Panel
Albumin (82040)
Calcium (82310)
Carbon dioxide (bicarbonate) (82374)
Chloride (82435)
Creatinine (82565)
Glucose (82947)
Phosphorus inorganic (phosphate) (84100)
Potassium (84132)
Sodium (84295)
Urea Nitrogen (BUN) (84520)

3283-9 Acute Hepatitis Panel
Hepatitis A antibody (HAAb), IgM antibody (86709)
Hepatitis B core antibody (HbcAb), IgM antibody (86705)
Hepatitis B surface antigen (HbsAg) (87340)
Hepatitis C antibody (86803)

3422-3 Hepatic Function Panel/Liver Panel
Albumin (82040)
Bilirubin, total (82247)
Bilirubin, direct (82248)
Phosphatase, alkaline (84075)
Protein, total (84155)
Transferase, alanine amino (ALT) (SGPT) (84460)
Transferase, aspartate amino (AST) (SGOT) (84450)

0002-6 Electrolytes Panel
Carbon Dioxide (bicarbonate) (82374)
Chloride, blood (82435)
Potassium, Serum (84132)
Sodium, Serum (84295)