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Ambetter labs

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Centene, which is Ambetter and Magnolia’s parent company, has had a policy in place for it’s Medicaid Advantage products concerning the reimbursement of in-office lab charges since 2017. Beginning 5/1/2019 the same reimbursement policy has been implemented for it’s marketplace prod-uct, which is Ambetter. We have noticed that clinics have been receiving a letter stating this policy and some have noticed denials of previously paid lab services. The policy essentially identifies a list of lab services that will be reimbursed when performed by in-office labs. Any lab work performed in the office that is not on this list will NOT be reimbursed. The policy extends to all providers. Centene’s position is that there are lab results that are necessary at the time of the visit that are required for proper diagnosis and treatment. These labs are referred to as Short Turnaround Time (STAT) labs. Labs which do not fall into that category should be submitted to a reference lab for processing and billing.If you have an in-house lab, make sure you are billing only for the lab work for which you will be reimbursed. Also, review your EOB’s for denials for services which should be paid.

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