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Specialty Charges

Lab Charge Set Up

When Lab services are a part of any billable transaction, there may be one of two types. Each type requires a slightly different set up, depending on the service:

• No Purchased Services: The office bills for the drawing of the specimen

• Purchased Service, Outside Lab Billing: The office sends the patient to the lab for everything, the lab bills the offices, and the office bills the insurance.

No Purchased Services

Set up the fields as indicated:

1. Utility --►Procedure

1.1 Status                     

Must be set to L.

1.2 Cost                        

Must be left at 0.00 (zero).

2. Utility --►Provider

2.1 CLIA                        

Must have a CLIA Number.

3. Utility --►Insurance

3.1 Print CLIA (Y/N)    

Must = 'Y.'

4. Utility --►Facility

Create a Utility --►Facility for the lab where the specimen will be sent.

4.1 Type                        

Set to TL for the lab where the specimen will be sent.

4.2 Qualifier                  

Required for electronic claim submission. Where lab charges are involved, this should be set to X4.

5. Charges --►Charge

5.1 Facility                     

Must match the Utility --►Facility <Facility Code> for the lab where the specimen will be sent.

Purchased Service, Outside Lab Billing

Set up the fields as indicated:

1. Utility --►Procedure

1.1 Status                     

Must be set to L.

1.2 Cost                        

Must be completed with the lab's fee.

2. Utility --►Facility

Create a Utility --►Facility for the lab where the specimen will be sent.

2.1 Name                      

Must be completed.

2.2 Address                  

Must be completed.

2.3 Type                        

Set to TL for the lab where the specimen will be sent.

2.4 NPI                           

Must be completed.

2.5 CLIA                        

Must be completed.

2.6 Qualifier                  

Required for electronic claim submission. Where lab charges are involved, this should be set to F4.

3. Charges --►Charge

3.1 Facility                     

Must match the Utility --►Facility <Facility Code> for the lab where the specimen will be sent.

4. Charges --►Encounter --►Generic

4.1 Referred Lab           

Must match the Utility --►Facility <Facility Code> for the lab where the specimen will be sent.

NOTE: If billing includes some charges with their CLIA and some as purchased service, they must be billed on separate claims.

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