Effective 1/1/23, SmartHealth implemented changes to the laboratory billing procedures that may impact the way your laboratory claims are processed. It is important for your provider to bill your lab services according to the new guidelines to avoid any claims payment issues.
To determine Tier 1 laboratories available within your ministry, please view the provider directory, or click here to view SmartHealth’s national lab agreements. If you cannot find a covered lab near you, many Ascension ministries have lab services that will be covered at the Tier 1 network. Be sure to ask your ordering provider's office to direct you to a Tier 1 lab near you to ensure the highest coverage from SmartHealth.
Important to note:
-
Only the labs on the preventive care services list will pay at 100% with a routine diagnosis code.
-
Diagnostic lab test claims (complete blood count, thyroid levels, chemistry panels) will be paid after copays, coinsurance and/or deductibles if the appropriate medical diagnosis is on the claim.
This is a change to how labs have processed in the past. Previously, all labs ordered with routine diagnoses would pay at 100%. Please check the SmartHealth website to view the Ascension Network (Tier 1) in-network labs and request that your lab tests be sent to one of those laboratory providers.
Click here to view the list of SmartHealth National Ancillary Providers.