The CPT and Medical Necessity information that PHL provides are to be used as guides. This information is subject to change on a regular basis and it is the client’s responsibility to verify accuracy of the information given to the laboratory.

You should refer to the most current version of the published manuals to resolve any issues: 
        CPT coding manual published by the American Medical Association
        LMRP/NCD manuals published by the Administar and CMS

GENERAL BILLING INFORMATION 

Insurance Billing

Parkview Health Laboratories submits claims to Medicare and Medicaid for Indiana and Ohio. We are participating providers in many PPO's and HMO’s.  PHL will also file with commercial insurance companies as a courtesy to our patients.  For a complete listing of accepted insurances please contact the billing department at 260-373-9420

On the Parkview Health Laboratory requisition in the BILL TO: section, Mark 
[  ]INSURANCE / PATIENT. 

The following information is required in order for us to submit a claim for our services:

Patient: Full Legal Name 
Responsible Party: Name
Date of Birth Social Security #
Gender Employer
Relationship to Patient
Address

Insurance: Insurance Name (payor name and network name)
Policy Holder Name
Policy Holder Employer
Relationship to patient
Policy #
Group #
Claims Address
**** Please include a copy of the front and back of the insurance card(s) with requisitions ****

Diagnosis: Reasons each test is being ordered. 

**** When ordering tests for Medicare and Medicaid patients, please select only those tests which are medically necessary for the diagnosis or treatment of the patient. Medicare does not generally pay for the routine screening tests or those they consider not medically necessary. When ordering testing for patients who are asymptomatic, solely for the purpose of screening, please indicate that the test is being ordered to screen for a particular condition. Medicare patients will be billed for screening tests not covered by Medicare. If a test is being ordered to rule out a condition you suspect because of specific symptoms present in the patient, please document the symptoms as the reason(s) for the testing. **** 

**** We cannot file claims with any carrier (Medicare, Medicaid, and Insurance) without diagnosis information. Diagnoses (reasons for testing) include symptoms, conditions, complaints, therapeutic medications directly related to the tests, which are documented in the patient's chart as the reason the testing is being ordered. ****

Must include the Physicians Printed First and Last Name and Signature 

Account Billing

If you want PHL to bill your account, simply mark o ACCOUNT in the BILL TO: area of the
requisition. You will receive an itemized monthly statement listing each patient’s services for that
month. Please provide us with the following information:

Patient: Full Legal Name Physician: First and Last Name
Date of Birth Signature
Gender 

Patient Billing (No Insurance Coverage)

For your patients who have no insurance coverage, or who do not wish for their insurance to be filed, please mark; 
[  ]PATIENT ONLY – NO INSURANCE 
in the BILL TO: section of the requisition. Please provide us with the following information on the requisition:

Patient: Full Legal Name Responsible Party: Name
Date of Birth Social Security #
Gender Employer
Relationship to Patient
Address
Physician: First and Last name
Signature


Medicare ABN 

The Advanced Beneficiary Notice (ABN) is a notice given to beneficiaries in Original Medicare to convey that Medicare is not likely to provide coverage in a specific case. “Notifiers” include physicians, providers (including institutional providers like outpatient hospitals), practitioners and suppliers paid under Part B, as well as hospice providers and religious non-medical health care institutions (RNHCIs) paid exclusively under Part A. They must complete the ABN as described below, and deliver the notice to affected beneficiaries or their representative before providing the items or services that are the subject of the notice. (Note that Medicare inpatient hospitals, skilled nursing facilities (SNFs), and home health agencies (HHAs) use other approved notices for this purpose.) The ABN must be verbally reviewed with the beneficiary or his/her representative and any questions raise during that review must be answered before it is signed. The ABN must be delivered far enough in advance that the beneficiary or representative has time to consider the options and make an informed choice. Employees or subcontractors of the notifier may deliver the ABN. ABNs are never required in emergency or urgent care situations. Once all blanks are completed and the form is signed, a copy is given to thebeneficiary or representative. In all cases, the notifier must retain the original notice on file.

Advanced Beneficiary Notice (ABN)  Form Instructions

Advanced Beneficiary Notice (ABN) Form