Reference labs

Applies to:

All plans

Definition

Reference labs are tests sent out for further testing and results.

Reference labs billing

In some cases, participating hospitals and other providers must contract with reference labs for further testing and results. If the reference labs are non-participating, the participating provider is responsible for paying the non-participating facility.

• Participating facilities/providers should bill Priority Health for all member laboratory services, including those requested from non-participating labs.
• Priority Health will then pay the participating facility/provider for approved services based on the universal facility, pathology, or laboratory fee schedule, depending on the provider's contract.
• If the participating facility/provider is not satisfied with the payment, they may ask Priority Health for additional reimbursement on a case-by-case basis by sending a written request to Priority Health using a Provider Level I Appeal form. Go to Reviews and appeals for more details.