Contact us
Phone/fax:
Phone: (612) 863-0400
Fax: (612) 863-0460
Mailing address:
Allina Health Laboratory Billing
MR 20201
PO Box 342
Minneapolis, MN 55440-0342
Cancellation of testing
Reflex testing
Reflex tests have a defined reflex test protocol. That is, based on the ordered test results, additional testing if required will be performed, reported, and billed at an extra charge. These additional tests are necessary to complete the diagnostic information needed for patient treatment. Notification by the provider is necessary if reflex testing is not desired. Please refer to the Reflex test list for a complete listing. This listing is updated annually.
Pathology billing
Allina Health Laboratory contracts with Hospital Pathology Associates (HPA) for pathology services. If your patient is being billed for any type of pathology service, they will receive a separate bill from HPA.
Patient information, including insurance, is needed for all cases that have pathology involvement, even if AHL is billing your facility. If we do not receive this information with the specimen, it will necessitate correspondence with your billing department to obtain the missing information, and may cause delays in patient results.
The form linked below can be shared with your patients to help explain this billing.
The ICD-10 code sets allow providers to document more details about their patients’ health conditions and hospital procedures than ever before. These details lead to a better record of a patient’s history, and in turn, lead to better care for patients across different providers. Previously, for example, a provider used an ICD-9 code to indicate a patient has a broken arm. With ICD-10, the provider uses a more specific code to indicate whether it’s the right or left arm broken, providing a better understanding of the patient's injury or condition.
If you would like further information, you can refer to the Centers for Medicare & Medicaid Services (CMS) website.
Centers for Medicare & Medicaid Services
CMS Principle/primary diagnosis code edit
The Centers for Medicare & Medicaid Services (CMS) has a policy which defines a list of diagnosis codes that will never be accepted as the first diagnosis on a claim. The unacceptable principal/primary diagnosis list is defined by the Medicare Code Editor (MCE) but there are some exclusions to the MCE list due to current OPPS coding requirements and guidelines.
When completing the Allina Health testing request form, the principle/primary diagnosis code should be indicated in the first diagnosis code box. If a client submits work to Allina Health Laboratory with no acceptable principle/primary diagnosis code, our billing department will contact you requesting additional information.
The CMS Quarterly Release files listings are located on this site: OCE Quarterly Release Files | CMS. Click on the current link for the OCE Quarterly Data Files and accept the End User Point and Click Agreement. When the zip file opens, choose the Report-Tables folder, then the Data_DX10 Excel file.
If you have any questions regarding this, contact CMS for further information.
Medical Necessity
Advanced beneficiary notice (ABN)
Medicare does not pay for most screening tests or tests deemed experimental or not medically necessary. In order to comply with the Center for Medicare/Medicaid Services (CMS) payer notification guidelines, Allina Health Laboratory must have documentation that the patient was notified that the insurer might not pay, and in that event, is willing to accept responsibility for these charges. A completed CMS approved Advanced Beneficiary Notice (ABN) must be signed by the patient and submitted with the specimen.
Allina Health Laboratory will continue to bill Medicare for services performed for its clients. To meet the Centers for Medicare/Medicaid Services (CMS) regulatory requirements mandating acceptable frequency, acceptable ICD codes, and determination of when a patient may have last received testing categorized as a frequency test, Allina Health Laboratory will require an ABN to be completed for a Medicare (and some Medicare Replacement Products) patient presenting to one of the patient care service centers or Metro Hospital Laboratory Reception areas when National Coverage Decision testing is ordered without ICD diagnosis codes justifying medical necessity.
ABN's advise beneficiaries, before items or services are actually furnished, when Medicare or its replacement products are likely to deny payment from them.
If testing does not come under Medicare guidelines for payment, a signed ABN must be included.
If a patient should request not to have testing performed once the ABN has been presented, Allina Health Laboratory will not notify the provider that the patient decided not to have the testing performed but recommend that the patient themselves call and let the provider know directly. Allina Health Laboratory will document in the patient’s medical record that the patient decided not to have the testing performed. * In certain situations the patient may refuse to sign the ABN but still insist on the testing. In these cases two employees can sign the form attesting to the understanding of the patient that they are financially responsible for the testing if Medicare denies. If Medicare or a Medicare replacement denies payment based on screening, frequency or medical necessity, the patient is then responsible for these charges. If you are unable to get your patient to sign the ABN, Allina Health Laboratory’s bill back policy will be enforced.
Who is responsible for collection of the ABN?
The facility who collects the sample for testing is responsible for presenting the waiver to the patient for review and signature.
If the sample is collected at your facility, the ABN must be completed and submitted with the sample; if the patient is sent to Allina Health Laboratory to have specimens collected, then it will be the responsibility of Allina Health Laboratory to collect the ABN.
What do I do with the completed ABN?
The original copy of the ABN stays in the clinic for clinic documentation. Copies should be made to send to Allina Health Laboratory and to be given to the patient. Patients are responsible for yearly deductibles, co-payments, and any balance not covered by the insurance company.
ABN and Non-covered services waiver test list
How to complete an Advanced beneficiary notice (ABN)
Certain Medicare Replacement plans follow the CMS medical necessity policies. These plans will not accept the CMS ABN form. The Non-covered services waiver should be used for these plans.
The form is similar to the CMS ABN. It requires the service to be listed, the estimated price, the reason for the non-coverage and the date of service. This should be filled out prior to presentation to the patient.
Non-covered services waiver FAQ
Non-covered services waiver example
Molecular medicare billing
Hospital clients submitting a request for an assay on an outpatient with Medicare with CPT codes between 81105-81599 should complete and submit a Molecular Medical billing request to notify us of the need for Allina Health Laboratory to bill insurance for Molecular testing performed.
Molecular Medicare billing request
Lab NCD’s ICD-10
Lab NCD's-ICD 10
In the downloads box found at the link above, select the month/year prior to the date of service in question to access the correct file.
Each of the links below will take you to a CMS (Centers for Medicare & Medicaid Services) License Agreement page where you much read and indicate your acceptance of the terms.
CMS is not providing the links to the articles that replaced the LDC’s directly. However, at the bottom of each LCD, under the Associated Documents header, there is a hyperlink to the article that lists the CPT and the covered codes. This is the only way to access these new articles at this time.
B-type Natriuretic Peptide (BNP) testing (L33573/A56767)
Biomarker Testing (Prior to Initial Biopsy) for Prostate Cancer Diagnosis (A56609)
Heavy metal testing (L35074/A56767))
Molecular Pathology procedures (L35000/A56199)
Multimarker serum tests related to ovarian cancer testing (L38371/A57020)
RAST type tests (L33591/A56844)
Urine drug testing (L36037/A56761)
Vitamin D assay testing (L37535/A57736)
Cytogenetics studies
National Coverage Determination (NCD) for Cytogenetics Studies (190.3)
CMS MLN Matters; Coding revisions to National Coverage Determination (NCDs)
In the middle of page 2 of this document, there is a link to downloadable listings. Click on the link, click open, and choose the MM11491 link.
Screening for Hepatitis B virus
National Coverage Determination (NCD) for Screening for Hepatitis B virus (210.6)
ABN's and waivers do not apply for payor specific coverage policies. If a covered ICD is not received, charges for testing will be billed back to the ordering site.
Aetna
Cardiovascular Disease Risk Tests Medical Clinical Policy Bulletins | Aetna
Colorectal Cancer Screening - Coverage Policy 0516
Homocysteine - Coverage Policy 0763
Cigna
Vitamin D - Coverage Policy 0526
Nucleic Acid Pathogen Testing (cigna.com)
United Healthcare (UHC)
Hepatitis screening – Coverage Policy 2021T0548X
Vitamin D - Coverage Policy 2022T0631A
United Healthcare (UHC) Medicaid product
It is your responsibility to determine the correct CPT codes to use for billing. CPT codes provided by Allina Health Laboratory in our test catalog, or by our billing department, are for informational purposes only. This coding is based on the Current Procedural Terminology (CPT) guideline manual published by the American Medical Association and the local and third party payer requirements. Any questions regarding the use of a code should be referred to your local Medicare carrier or the payer being billed.
Requests for missing information required for submission of an insurance claim will be emailed to designated contact(s) for each account. It is the responsibility of the client to respond timely with the requested information; failure to do so will result in charges being billed back to your account.
Types of requests may include:
Corrections - Forms & Instructions
Insurance adjustment form
When making billing adjustments, it is important that we understand exactly how you would like us to bill each patient’s labs. When a billing correction is requested, we need the most accurate and up to date information in the clearest format possible.
The insurance adjustment form lists all the information needed in a clear and organized format. This makes it easy for our billing staff to determine which patient you want us to change the billing for, which tests, which DOS, and which insurance if any should be billed.
How do I fill it out?
The form can be filled out by hand, or you can type directly into the form linked below. All fields on the Insurance Adjustment Form are required to be filled out.
To remove charges from your account and bill to patient's insurance, you must provide the following:
Insurance adjustment form (fillable PDF)
Adjustment form example:
Insurance adjustment form example
How do I submit the forms to Allina Health Laboratory Billing for processing?
Requests for billing changes must be submitted within 60 days of invoice receipt. Forms can be submitted by fax or e-mail. If you filled out the form online be sure to save a copy for your records. You can send us a copy of the saved form as an attachment in e-mail form. This is the quickest and clearest way of submitting adjustment forms. This copy also serves as a reference for you to watch for these credits to appear on your next statement.
When Allina Health Laboratory receives the adjustment forms
When we receive the forms, we inspect each one to make sure all required information is present and that it is clear enough to make an accurate correction. The following are additional policies not already covered above:
Questions or concerns?
If you have any questions about how to complete the form or about our billing policies, you can reach our billing office at (612) 863-0400. We are more than happy to work with you to make the billing process easier, so if you have any suggestions, please let us know.
Dependent up the type of facility, you may have the option for one or more of the of the following billing types for services performed by our laboratory.
If your facility has more than one billing option, you must check which billing option you prefer on each test requisition. If you do not check a box to indicate how the work is to be billed, or if it is marked inappropriately, it can result in incorrect bills to you or your patients.
If no billing preference is indicated on the request along with your sample, charges will be billed to the entity ordering the laboratory service. If your patient presents at one of our patient service centers and no billing option is marked, Allina Health Laboratory will default the billing to the patient's insurance/self pay option.
The ability to customize your site's requisitions allows for you to pre-set your bill type. For example, if your site always has Allina Health Laboratory bill the patient’s insurance then the phrase “Always Bill Patient’s Insurance” can be printed directly onto your hand written requests. Please talk to your Allina Health Laboratory Account Representative to get more specific information on this preprint option.
Client Billing
The invoice:
Itemized billing statements are sent on a monthly basis.
The invoice indicates the date of service, patient name, CPT code, test name, and test charge. Should you feel any portion of the statement is in error, please notify us within 60 days. Refer to the Billing corrections tab for additional information.
How to remit payment
Payment is due upon receipt of the invoice and can be made by electronic check (ACH) or credit card via the client billing portal. No transaction fees will be charged for online payments.
If unable to pay online, submit check, payable to Allina Health Laboratory. The following must be included to ensure accurate posting and avoid payment delays:
Questions, concerns and/or access issues can be emailed to AHLOutreach@allina.com and someone will get back to you as soon as possible.