BCN to deny claims for unauthorized outpatient toxicology laboratory services by non-JVHL laboratories starting Jan. 1, 2020

Effective Jan. 1, 2020, BCN will deny claims for outpatient toxicology laboratory services provided by an out-of-network laboratory without authorization from Joint Venture Hospital Laboratories. This applies to BCN HMO^SM (commercial) claims.

BCN contracts with JVHL to provide the statewide provider network for all outpatient laboratory services. This means:

• Claims for outpatient toxicology laboratory services are eligible for payment only if the service provider is affiliated with JVHL or proper authorization is obtained from JVHL for out-of-network services.
• Claims for outpatient laboratory services must be submitted to JVHL
• Referring providers should use JVHL network laboratories.
• To obtain a service that is not provided by a JVHL laboratory, you must first submit a request for clinical review to JVHL.

Here's additional information you need to know regarding toxicology laboratory testing:

• It is the responsibility of the physician who orders the toxicology laboratory services to know whether the laboratory is in network and whether the procedure is covered by BCN. This information can be verified by JVHL.
• The procedure must be properly authorized before the service is provided and before the specimen is directed to an out-of-network laboratory.
• A BCN member whose toxicology laboratory services are denied as out of network may not be balance-billed.

For assistance in identifying a JVHL network laboratory, call the JVHL administrative offices at 1-800-445-4979. JHVL business hours are 8 a.m. to 4:30 p.m. Monday through Friday; they are closed during the lunch hour, from noon to 1 p.m. (All times are Eastern time.) Messages can be left 24/7 and a return call will be placed during business hours.

Posted: October 2019
Line of business: Blue Care Network