We would like to remind you that Independence does not allow pass-through billing for covered services. In accordance with your Provider Participation Agreement, you may bill Independence only for covered services that you or your staff perform. Participating providers are not permitted to submit claims for services that they have ordered, but they have not rendered (also known as ?pass-through? billing). For example, pass-through billing by a physician practice of laboratory services performed by a third-party laboratory is not reimbursable by Independence.
You should use an Independence-contracted laboratory to perform pathology services for Independence members, including both the technical portion and the professional portion of the services. The laboratory should bill Independence directly for services it performs ? they should not attempt to bill your practice for services.
As a reminder, as of April 1, 2018, claims submitted for pathology services that are billed by an office-based pathologist will be denied. However, dermatologists who perform certain pathological procedures in their office (at the time of a patient?s visit) may bill Independence for the service. For more information, refer to the Partners in Health UpdateSM article, Changes for pathologist reporting services in the office setting, published on February 13, 2018.