2013 Practitioner and Provider Manual - Presbyterian Healthcare ...

Care Coordination7. Laboratory Services7. Laboratory ServicesPresbyterian uses the Clinical LaboratoryImprovement Amendments (CLIA) waive test list forlaboratory services. The list applies to allPresbyterian product lines, and is effective fordates of service on or after January 1, 2014.Reimbursement for these pathology/laboratoryservices is based on Presbyterian’s Clinical Lab feeschedule, unless your contract states otherwise.Please note that certain Current ProceduralTerminology codes are restricted to specificspecialties.The CLIA waive test list can be located athttp://www.cms.gov/Regulations-and-Guidance/Legislation/CLIA/downloads/waivetbl.pdf.The list includes pathology/laboratory services thatmay be performed in the physician’s office. The listincludes a description identifying codes along withany limitations for each service. It is theresponsibility of the provider to establishappropriate CLIA waive test certification, or to applyfor a CLIA waive test certificate, if the choice ismade to perform any of these services.Reimbursement for these services remains at thecurrent Presbyterian fee schedule and payment issubject to the member’s eligibility, benefit plan, andbenefit limitations.Mexico. TriCore is the only laboratory service withinthe Presbyterian network at this time. Using orreferring to another laboratory service could resultin unnecessary additional expenses for yourpatients and violate the terms of your Agreementwith Presbyterian. Please be advised thatPresbyterian is monitoring all non-contractedlaboratory use.Please be aware that non-contracted laboratoriesmay solicit health care professionals belonging toour network with the assertion that they can accept“Presbyterian insurance.” Presbyterian willcommunicate with you to keep you informed of anyfuture network changes.A complete list of TriCore locations and contactinformation is available athttp://docs.phs.org/idc/groups/public/@phs/@php/documents/phscontent/pel_00078812.pdf.If you have issues or questions, please contactyour provider network management relationshipexecutive athttp://docs.phs.org/idc/groups/public/%40phs/%40php/documents/phscontent/pel_00140718.pdf.Using Contracted Laboratory ServicesTriCore Reference Laboratories is Presbyterian’sexclusive, independent contracted laboratory andprovides laboratory services throughout New7-12014 Practitioner and Provider Manual - Ver. 3