Insurance Billing Requirements

See sample billing requisitions for specific examples of how to complete the requisition form to have us bill your office, patient, Medicare/Medicaid or other insurance.

Managed HealthCare NW
Refer to the MHN Administrative Manual for a complete listing of participating insurers.

Medicare
We bill Medicare directly. If the patient's Medicare coverage is through an HMO/PPO, (i.e., Blue Cross Medicare Advantage, Secure Horizons) please specify which carrier.

The patient is billed only for tests not covered by Medicare or co-insurance charges. Please provide ICD-9 code, the patient's date of birth and Medicare number with identifying letter and referring physician name, address and NPI number. If the patient has other insurance coverage and Medicare, please note which plan is primary.

Kaiser
A copy of the authorization must be included when submitting tests for patients covered under Kaiser health plans with the exception of open option plans.

Oregon Medical Assistance Program and Washington DSHS
We bill Medicaid directly. Please submit the physician's provider number, the patient ID number and indicate health plan if applicable (Care Oregon, CUP, Family Care Lane OHP).

United Healthcare (UHC)/PacifiCare/Secure Horizons/PacifiCare Direct
We bill the plan or the clinic administering these plans. Clearly indicate the appropriate plan, the name of the administering clinic if applicable, primary care physician and patient's date of birth on the laboratory request form.

Providence Health Plan
Prior authorization may be required when submitting clinical testing. Please verify the authorization requirements of the specific Providence Health Plan.

Workman's Compensation
Please provide the claim number, Social Security number, date of injury, name of the employer, and indicate the name and address of the insurance company. (Examples: SAIF, Liberty Northwest, Caremark Comp.)

NOTES:
Prior authorization may be required
Prior authorization for testing can vary by insurance plan
For more information, please contact your health plan provider directly.

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