Reference laboratory billing for hospital laboratories
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Rules for McLaren Health Plan contracted hospital laboratories billing for laboratory tests performed by external reference laboratories, including requirements for certification, contracts, and pre-authorization when applicable.
No material clinical or coverage changes in this revision.
Billing conditions for reference laboratory services
Billing conditions for reference laboratory services
Contracted hospital laboratories may bill McLaren Health Plan for reference laboratory services only when ALL of the following conditions are met:
ALL of the following
- Reference laboratory holds required CLIA certification and State licensure if required.
- Contracted hospital laboratory and reference laboratory have a contractual agreement obligating the hospital laboratory to reimburse the reference laboratory for services.
- If the service requires pre-authorization, the contracted hospital laboratory has requested and received pre-authorization from McLaren Health Plan and included the pre-authorization number on the claim.
Codes and claim requirements
| 80000-89999 | Range of CPT laboratory procedure codes referenced |
Provider requirements and actions
Obtain and document pre-authorization for covered reference lab services
If a referenced laboratory test requires pre-authorization, the contracted hospital laboratory must request and receive pre-authorization from McLaren Health Plan and include the pre-authorization number on the claim.
- Obtain McLaren Health Plan pre-authorization before the reference laboratory performs the service when pre-authorization is required.
- Include the pre-authorization number on the claim submission.
Key definitions
OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.