Hospital Reference Lab Protocol Changes

Effective April 1, 2021, for Oxford¹ benefits plans, hospitals acting as a Reference Laboratory or conducting diagnostic testing for non-patients cannot bill for such non-patient diagnostic laboratory tests under that hospital’s Facility Participation Agreement.

Hospitals wishing to perform these laboratory and diagnostic services for Oxford members may apply to be credentialed and contracted as a Reference Laboratory in our Oxford commercial networks².

Definitions

• Reference Laboratory: A laboratory that performs diagnostic testing on specimens it receives from other referring laboratories or care providers
• Non-patient: Is a member that is neither an inpatient nor an outpatient of a hospital, but for whom a specimen is submitted for laboratory testing to a hospital

What Hospitals Need to Do

To contract your hospital as a Reference Laboratory, please contact your network representative to begin the credentialing and contracting process.

Claims submitted for non-patient diagnostic laboratory tests or claims where a hospital is acting as a Reference Laboratory will be denied for failure to comply with this protocol in the event a hospital is billing under its Facility Participation Agreement.

Questions? Please contact your network representative.

¹ Oxford insurance products are underwritten by Oxford Health Insurance, Inc. Oxford HMO products are underwritten by Oxford Health Plans (NJ), Inc. and Oxford Health Plans (CT), Inc. Administrative services provided by Oxford Health Plans LLC.

² The Oxford networks include Freedom, Liberty and Metro.