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Pathologists Reminded to Follow Allowable Practice Locations for Pathologists Administrative Policy

As a participating pathologist, it’s important that the claims you submit for laboratory services are processed correctly. According to our existing administrative policy, Allowable Practice Locations for Pathologists, you may not bill for laboratory testing services administered in a non-hospital, office-based setting. Per the policy:

  • Pathology services can be provided in a hospital setting to members enrolled in Horizon managed care plans by a practice that participates in the Horizon Managed Care Network.
  • You must send Horizon patients and/or Horizon patients’ testing samples to participating clinical laboratories.

Effective January 1, 2022, according to this existing policy, all pathologist claims submitted for services billed with an office setting as the place of service for members in plans that access the managed care network (including, but not limited to, OMNIA℠ Health Plans, NJ Direct, HMO, EPO, POS and Medicare Advantage)will be denied.

To access this policy, please log in to NaviNet, select Horizon BCBSNJ from the My Health Plans menu and:

  • Mouse over References and Resources and select Provider Reference Materials
  • Mouse over Policies & Procedures and click Policies
  • Click Administrative Policies
  • Click Allowable Practice Locations for Pathologists

If you have questions, please contact your Network Specialist.

Published on: October 1, 2021, 11:19 a.m. ET
Last updated on: October 1, 2021, 14:07 p.m. ET