BCN to Deny Claims for Unauthorized Outpatient Toxicology Lab Services by Non-JVHL Labs Starting January 1st

Blue Care Network will deny claims for outpatient toxicology laboratory services provided by an out-of-network laboratory without authorization from Joint Venture Hospital Laboratories, starting Jan. 1. This applies to BCN HMOSM (commercial) claims.

BCN contracts with JVHL to provide the statewide provider network for all outpatient laboratory services. This means:

• Claims for outpatient toxicology laboratory services are eligible for payment only if the service provider is affiliated with JVHL or proper authorization is obtained from JVHL for out-of-network services.

• Claims for outpatient laboratory services must be submitted to JVHL.

• Referring providers should use JVHL network laboratories.

• To obtain a service that is not provided by a JVHL laboratory, you must first submit a request for clinical review to JVHL. What you need to know

• The physician who orders the toxicology laboratory services is responsible for knowing whether the laboratory is in network and whether the procedure is covered by BCN. This information can be verified by JVHL.

• The procedure must be properly authorized before the service is provided and the specimen is directed to an  out-of-network laboratory.

• A provider may not balance bill a BCN member whose toxicology laboratory services are denied as out of network.

Source: https://www.bcbsm.com/content/dam/microsites/corpcomm/provider/BCNPN/Assets/archive/2020/01/2020_01_BCNProviderNews-2020JanFeb.pdf