Independent Labs

Independent labs must file the claim to the Blue Plan in whose state the specimen was drawn. The ordering referring provider’s location will determine where the specimen is drawn. If the referring provider in box 17 is not a Nebraska provider, Blue Cross and Blue Shield of Nebraska will reject the claim and direct the lab to file to the Blue Plan where the referring provider is located. To prevent physician offices from being impacted by the ancillary claim filing guidelines when submitting charges for laboratory services, it is important to use Place of Service (POS) 11 (office) when filing your claim. Only a laboratory referring services to another laboratory should use modifier -90.  

POS 81 is to be used only by independent laboratory providers, which are defined as “a laboratory certified to perform diagnostic and/or clinical tests independent of an institution or a physician’s office.” Physician offices who bill for laboratory services sent to an independent clinical laboratory should NOT assign POS 81 to the service line(s) in which the laboratory is reported on the claim.  

Note: This applies to freestanding, independent clinical laboratories only. Claims for laboratory services provided in a hospital setting or billed by a physician’s office should be sent to the Blue Plan in the state where the laboratory services were performed.