Non-participating reference lab billing
In some cases, participating hospitals and other providers must contract with reference labs for further testing and results. If the labs are non-participating, the participating provider is responsible for paying the non-participating facility.
Requesting reimbursement
- 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 on a fee-for-service or capitation basis, 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 (140KB PDF). Go to instructions and documentation requirements for filing this form.
