Effective 1/1/23, SmartHealth implemented changes to the laboratory billing procedures that may impact the way your laboratory claims are processed. It is important for your provider to bill your lab services according to the new guidelines to avoid any claims payment issues.
Many Ascension ministries have lab services available within their own facilities. In those situations, those lab services should always be used. To determine Tier 1 laboratories available within your ministry, please view the provider directory, or click here to view SmartHealth’s national lab agreements.
Important to note:
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Only the labs on the preventive care services list will pay at 100% with a routine diagnosis code.
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Diagnostic lab test claims (complete blood count, thyroid levels, chemistry panels) will be paid after copays, coinsurance and/or deductibles if the appropriate medical diagnosis is on the claim.
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Members should only get labs drawn at a hospital facility if there is no other option. Hospital lab billing procedures differ from other outpatient lab billing, therefore may cause a delay or denial in claims.
This is a change to how labs have processed in the past. Previously, all labs ordered with routine diagnoses would pay at 100%. Please check the SmartHealth website to view the Ascension Network (Tier 1) in-network labs and request that your lab tests be sent to one of those laboratory providers.
Click here to view the list of SmartHealth National Ancillary Providers.