Private Insurance and Managed Care Organizations

As a service to your patients, and in compliance with agreements established with insurance and managed care companies, UIDL will bill your patient’s insurance carrier(s) or managed care organization directly when provided with complete and accurate billing information. For those insurance companies and managed care organizations where a contract does not exist with UIDL, we will still file a claim to those carriers. Your patient may or may not have out-of-network coverage. It is the patient/provider’s responsibility to vet insurance carrier coverage. This includes determining whether prior authorization is needed and whether the patient has out of network laboratory benefits which will allow payment to UIDL

Below is information required by the payer to determine coverage and/or prior authorization requirements. Additional information (e.g., CPTs) are available via the UIDL Test Directory. Please contact the UIDL Reference Billing Team via email (UIDL-Billing@uiowa.edu) or phone (866-844-2522) if additional details are required or if there are any questions.

Medicare Advance Beneficiary Notice of Noncoverage (ABN)

UIDL will bill Medicare when appropriate. However, Medicare does not cover all tests, even when the patient or health care provider believes the testing is medically necessary. When Medicare coverage is uncertain or denial is anticipated, an ABN is required.

A properly completed ABN allows UIDL to bill the patient if Medicare denies the claim for the reason identified on the ABN. In the absence of a properly completed ABN, UIDL may bill denied charges back to the referring institution.

The referring institution is responsible for determining whether an ABN is needed and ensuring the patient has enough information to make an informed decision, including the specific test or service, the reason Medicare may not pay, and the estimated cost. The tests listed below are known to commonly require an ABN; however, this list is not exhaustive.

A template ABN is available for use:

View ABN  

ABN completion requirements

The ABN must include the following:

1. Notifier, patient, and optional identification information

   The notifier name, address, and phone number must be completed. The patient’s name must also be included. The identification number field is optional and may be used for an internal patient or order identifier. Medicare Beneficiary Identifiers and Social Security numbers should not be included.

2. Test, reason Medicare may not pay, and estimated cost

   The ABN must identify the specific item, test, service, or care that may not be covered, the reason Medicare may not pay, and a good-faith estimated cost.

3. Patient selection of one option

   The patient or authorized representative must choose only one option. UIDL and the referring institution cannot choose an option on the patient’s behalf.

   Option 1: The patient wants the testing performed and wants Medicare billed for an official payment decision. If Medicare denies the claim, the patient may be financially responsible and will retain Medicare appeal rights.

   Option 2: The patient wants the testing performed but does not want Medicare billed. The patient is responsible for payment and does not have Medicare appeal rights because Medicare will not be billed.

   Option 3: The patient does not want the testing performed. The test should not be submitted to UIDL.

4. Signature and date

   The patient or authorized representative must sign and date the ABN. Signing confirms the patient received and understands the notice.

Prepayment

UIDL may request prepayment when the patient selects either Option 1 or Option 2, subject to applicable law, payer requirements, and institutional policy.

If the patient selects Option 1, UIDL will bill Medicare for an official payment decision. If Medicare pays the claim, UIDL will refund any patient payment made in advance, less any applicable co-pays or deductibles. If Medicare denies the claim, the patient may be financially responsible and retains Medicare appeal rights.

If the patient selects Option 2, UIDL will not bill Medicare, and the patient is responsible for payment.

For patients with Medicaid, QMB, or other secondary coverage, patient billing and prepayment requirements may be limited and should be reviewed before collecting payment.

Prepayment may also be requested or required when:

• A properly completed ABN cannot be obtained;
• The referring institution declines financial responsibility for charges that may be denied; or
• UIDL is otherwise unable to bill Medicare or transfer financial liability based on a valid ABN.

Important note

If the patient selects Option 3, testing should not be performed or submitted to UIDL.

Additional questions or concerns

Please contact the UIDL Reference Billing team via email (UIDL-Billing@uiowa.edu) or phone (866-844-2522) if you have any additional questions or concerns.

Iowa Medicaid

Medicaid claims can only be filed after all other third-party resources have been exhausted. Patients should be asked at the time of service if there is other coverage, such as Medicare, Medicaid HMO, or private insurance. When applicable, any Medicare, private insurance, or managed care (HMO) information should also be provided. If Medicaid denies payment for non-covered services or eligibility reasons, the patient may be responsible for the payment. Medicaid is always the last source of payment.

Non-Iowa Medicaid

The UIDL can only file Medicaid or state aid claims in Iowa. Prepayment is required before the UIDL will perform testing. To initiate payment and expedite testing, please complete the prepayment form.

Please contact the UIDL Reference Billing team via email (UIDL-Billing@uiowa.edu) or phone (866-844-2522) if additional details are required or if there are any questions.

As a service to patients, and in compliance with agreements established with insurance and managed care companies, UIDL will bill the patient’s insurance carrier(s) or managed care organization directly when provided with complete and accurate billing information. UIDL will work diligently to ensure claims are fully and properly adjudicated, and we do our best to obtain reimbursement from insurers. However, below are some of the circumstances that may result in a patient receiving a bill from UIDL include:

• The patient has non-government insurance and are responsible for a co-payment, co-insurance, deductible, and/or non-covered services.
• The patient has Medicare and is responsible for 20% of the amount Medicare has set as the cost of the test.
• The patient has Medicare and has signed an ABN (Advanced Beneficiary Notice). Once a claim is fully adjudicated, there may be a residual guarantor responsibility identified that the patient may receive a bill for directly from UIDL.
• Required prior authorization for testing was not properly obtained prior to testing.
• Additional information to successfully file insurance claims on the patient’s behalf was not received in a timely manner.

The patient should contact their insurance carrier directly, should they receive a bill from UIDL and feel their insurance claims were not processed correctly. If necessary, UIDL billing resources are always available via email (UIDL-Billing@uiowa.edu) or phone (866-844-2522).

UIDL produces patient statements once each month. The statements itemize the date of service (collection date), lab test(s), ordering provider, and applicable charge(s) for each test performed. Payment of the statement is due within 30 days of receipt.

Prepayment is required before UIDL will perform testing. To initiate payment and expedite testing, please read the prepayment section.

• UIDL TIN: 42-6004813
• UIDL NPI (Technical): 1811984636
• UIDL NPI (Professional): 1265433676

Please see Medicare Resources for ABN details and lab codes.

Medicaid coverage is only available to Iowa residents. Please visit Medicaid Resources to learn more.

Prepayment may be required. Learn more in the prepayment section.

The prepayment section provides details and circumstances that require prepayment.

Not all pricing is published. FSHD1 and FSHD2 pricing can be found at the FSHD1 and FSHD2 page. For other pricing inquiries, please contact the UIDL Reference Billing team via email (UIDL-Billing@uiowa.edu) or phone (866-844-2522) to confirm.

UIDL will work on behalf of the patient to obtain payment and reach out to referring institution to assist with facilitating an accurate and complete appeal, if necessary. Any residual guarantor responsibility, per the fully adjudicated insurance claim, will be directly billed to the patient. 

Yes, if the specimen is collected within the United States.

UIDL produces client invoices once each month. Payment of the invoice is due within 30 days of receipt.

• Prepayment will be required for samples collected outside of the United States. Please read the prepayment section to learn more.

• Browse our Test Directory to confirm test specific information.

• Browse our Test Directory to verify CPT codes for your specific test.
• CPT Codes are provided in the University of Iowa Diagnostic Laboratories Test Directory Handbook as a convenience to our clients. CPT codes are subject to change at any time; it is the client’s responsibility to verify their accuracy for the test performed. Clients are encouraged to consult the CPT Coding Manual published by the American Medical Association and to address questions regarding the use of any code to their local Medicare carrier.

• Visit the FSHD1 & FSHD2 page to access the test requisition, lab directory, and details related to testing and billing.

Proceed to the payment options section.