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Coverage
Considerations

Coding Guidelines for Payers

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Adhering to commercial payer policies is vital for ensuring coverage of patients testing. IHD Labs is dedicated to providing support to healthcare providers through guidance aligned with payer requirements and industry best practices. 

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Overview of Limited Coverage Policies (LCPs) 

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Commercial payers frequently implement Limited Coverage Policies (LCPs) that specify medical necessity coverage for various laboratory tests. To comply with these guidelines, it is essential for providers to ensure submitted ICD-10 codes accurately reflect the clinical indications justifying test orders. Non-compliance with these policies can result in claim denials or patient financial responsibility. 

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Supportive Resources 

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IHD Labs provides weekly LCP, additional and missing information to the practice via fax and client bill portals. The reference guides and links below are intended to assist healthcare providers in navigating complex payer policies in responding to these request.  

Best Practices for Accurate Test Ordering 

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To comply with coverage and reimbursement: 

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  • Confirm the specific test's status within the payer’s Limited Coverage Policy. 

  • Assign the medically necessity ICD-10 diagnosis codes with payer-approved indications. 

  • Prepare and submit necessary supporting documentation proactively. 

 

Please review the health plans listed above. The absence of any payers from this list does not indicate that a Limited Coverage Policy (LCP) does not exist. Additionally, the list of LCPs above is not exhaustive.  

Policy Notice on Investigational Services and Insurance Billing

 

At IHDLabs, we are committed to maintaining transparency and accuracy in our billing practices for all patients and providers.

 

Please be advised that services deemed investigational or experimental by insurance carriers will not be submitted for insurance reimbursement. These services are routinely denied by payers, regardless of provider recommendation or perceived medical necessity.

 

Accordingly, such services will be billed directly to the patient at our discounted Time-of-Service (TOS) rates. Patients who wish to attempt reimbursement on their own may request a completed CMS-1500 (HCFA) form, which we are happy to provide.

 

We strongly encourage all patients to verify coverage with their insurance provider prior to receiving services. If you have questions about whether a test may be classified as investigational, please contact our billing department at 1-800-820-8803 ext 2.

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Notice Regarding Non-Covered Laboratory Tests

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At IHDLab, we are committed to transparency in pricing and coverage. Some laboratory tests may not be covered by your insurance plan or may be denied if your plan determines that the service is not medically necessary, not included in your plan benefits, or performed outside of frequency or prior-authorization limits.

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When a test is not covered, you may be financially responsible for payment. Before any testing is performed, IHDLab will make reasonable efforts to inform you of potential out-of-pocket costs.


For certain health plans and Medicare beneficiaries, you may be asked to sign an Advance Beneficiary Notice (ABN) or similar acknowledgment form confirming your understanding of the possible non-coverage and your consent to proceed.

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How to Obtain Cost or Coverage Information

  • You may request an estimated cost for specific tests or a list of commonly non-covered services.

  • If you have questions about your insurance benefits or prior authorization, please contact your health plan directly.

 

Examples of Tests That May Not Be Covered

  • Certain genetic, pharmacogenomic, or wellness panels.

  • Screening or preventive tests performed without a physician’s diagnostic order.

  • Repeat or follow-up testing performed sooner than payer frequency limits allow.

 

IHDLab complies with all federal and state billing regulations, including the Clinical Laboratory Improvement Amendments (CLIA), Eliminating Kickbacks in Recovery Act (EKRA), and the No Surprises Act, ensuring fair and transparent billing practices.

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Disclaimer 

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The information provided in these guidelines and resources is intended for informational purposes only and does not represent an exhaustive list of all relevant details. IHD Labs is not liable for any errors, omissions, or reliance on the information provided herein. Providers should always verify coding and coverage details directly with individual payers. 

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For detailed guidelines and support, please reach out directly to the IHDLab billing support team. 

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