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.