Home Administrative Billing & Reimbursement BlueCard® Health and Wellness Medical PEAR portal Pharmacy Products Quality Management

Be compliant when you refer members for lab services

April 5, 2021

An Independence participating provider should refer members only to participating providers for covered services. This includes, but is not limited to, ancillary services such as laboratory and radiology, unless the provider has obtained preapproval from Independence for the use of a non-participating laboratory.

When applicable under the terms of your Independence Provider Agreement, if a provider continues to direct members and/or their lab specimens to a non-participating laboratory and does not obtain preapproval from Independence, the ordering provider is required to hold the member harmless.

The ordering provider will be responsible for all costs to the member and shall reimburse the member for such costs or be subject to claims offset by Independence for such costs. In addition, further non-compliance may result in a corrective action plan or immediate termination of your Independence Provider Agreement.

To learn more about compliance and what is required by your Provider Agreement, please visit our in-network laboratory services resource page.​​



This content was prepared for the Provider News Center and may not be reproduced in any way without the express written permission of Independence Blue Cross. Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association.
Connect with us     Facebook     Twitter     Flickr     YouTube     Walk the Talk    Independence Pinterest    Independence LinkedIn    Independence Instagram Site Map        Anti-Fraud        Privacy Policy        Legal        Disclaimer
© 2023 Independence Blue Cross.
Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association, serving the health insurance needs of Philadelphia and southeastern Pennsylvania.