CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Specimen provenance (Know Error) DNA testing — Payment/Coverage Policy

Policy governs coverage for the Know Error specimen provenance DNA test used to verify patient/specimen identity; applies to BlueCHiP for Medicare and Commercial products of Blue Cross Blue Shield - Rhode Island.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicySpecimen provenance (Know Error) DNA testing — Payment/Coverage Policy

Policy CodePolicy N/A

Change TypeNo material change

Effective Date2011

Next Review DateN/A

Key ActionDo not bill for Know Error testing — it is not covered and is considered provider liability under BlueCHiP Medicare and Commercial products.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Unlisted 84999reporting code

Provider liabilitycoverage stance

Not applicableprior auth

Coverage Determinations

Not covered / Provider liability

Coverage determination

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Use of the Know Error system is not covered and is considered part of hospital specimen quality control; therefore its use is provider liability for BlueCHiP for Medicare and Commercial products. Benefits may vary by group or contract—refer to the applicable Benefit Booklet, Evidence of Coverage, or Subscriber Agreement for specific coverage details.

Intended Use / Clinical Indications

Verification of specimen/patient identity to prevent specimen provenance errors

Intended clinical use (not covered)

Intended use: Verification of specimen/patient identity to prevent specimen provenance errors by comparing a tissue specimen to a pre-procedure reference DNA sample (Know Error system).

Although the document describes this intended clinical use, the test is considered part of hospital quality control and is not covered (provider liability) for BlueCHiP for Medicare and Commercial Products.

Provider Actions and Requirements

Prior Authorization

Prior authorization — Not applicable for this test.

Denial Risk

Coverage / Liability

The Know Error system is considered part of hospital specimen quality control. Use of this test for BlueCHiP for Medicare and Commercial products is not covered and is considered provider liability. Verify member benefits with the applicable Benefit Booklet, Evidence of Coverage, or Subscriber Agreement before ordering.

Applies to BlueCHiP Medicare and Commercial products
Benefits may vary by group/contract — confirm coverage in member documents

Documentation Required

Provider Process for Pre‑procedure Reference Sample

Obtain a pre‑procedure reference DNA sample and send it to an independent forensic laboratory following the kit instructions. A kit with bar‑coded specimen containers is provided to the surgeon; the surgeon places the reference specimen in the labeled containers and returns them to the pathology/laboratory for handling. If the forensic report is positive, the lab will compare the tissue specimen to the reference sample to confirm identity.

Collect reference DNA prior to the procedure
Use bar‑coded containers from the kit
Send reference sample to the independent forensic lab as instructed
Return the specimen to pathology/lab for processing

Denial Risk

Know Error — Provider Liability

Use of the Know Error system is not covered and is considered provider liability — do not bill expecting coverage. Confirm member benefits before performing the test; providers assume financial responsibility if performed without coverage.

Know Error testing is considered hospital quality control and non‑covered
Provider is liable for costs if test performed without coverage

Ordering and Specimen Handling

Note

Ordering requirements — pre‑procedure reference sample and bar‑coded kit

Ordering process requires collecting a pre‑procedure reference DNA sample and sending it (with the kit's bar‑coded specimen containers) to an independent forensic laboratory; specimens are returned to the pathology lab for evaluation.

Collect reference DNA prior to the procedure.
Use the kit with bar‑coded containers to label specimens.
Send reference sample and specimen containers to the independent forensic laboratory and return materials to pathology for evaluation.

Background

The Know Error system is a DNA-based specimen provenance test intended to verify specimen identity and reduce specimen provenance errors. Prior to the procedure a reference DNA sample is collected and sent to an independent forensic laboratory. A kit with bar-coded specimen containers is used; the surgeon places the specimen in the bar-coded containers and returns them to the pathology laboratory for evaluation. If a mismatch is reported, the forensic laboratory compares the tissue to the reference sample to confirm patient identity.

Definitions

DNA test used to verify the identity of specimens (Know Error system)

Test nameKnow Error (specimen provenance DNA test)

Purpose / definitionSpecimen provenance testing — DNA test used to verify the identity of specimens and help prevent specimen misidentification errors.

Process summaryPre-procedure reference DNA sample is taken and sent to an independent forensic laboratory; a kit with bar‑coded specimen containers is used; if mismatch detected, forensic lab compares tissue to reference sample to confirm identity.

Intended settingUsed by surgical/pathology teams as part of specimen handling and evaluation workflows.

Laboratory typeIndependent forensic laboratory performs the DNA comparison and confirmation.