The Centers for Medicare and Medicaid (CMS) require all providers (e.g., physicians, non-physicians and dentists) who order and refer tests or services for Medicare beneficiaries to be enrolled in PECOS. Claims (your own as well as the receiving laboratory’s) will be denied if the ordering/referring provider is not enrolled in PECOS.
The following link may be referred to for additional information and enrollment:
ProPath appreciates your attention to this matter so any services, including your own, ordered, referred and billed for a Medicare beneficiary is processed accordingly without delay.
If ProPath is denied payment due to non-enrollment, the client could be billed for the services rendered.
ProPath is a participating provider with most insurance companies. Please see your sales or service representative for a complete insurance list.
If the physician would like to be billed for a particular patient's testing, please check "ACCOUNT" under the "BILL TO" section of the requisition or online order form. Each client is billed once a month with an itemized invoice. Payment is due within thirty (30) days.
NOTE: Most states have laws/regulations addressing direct or pass-through billing. Health Plans also have contractual language and policies also related to this practice. Hospital-registered patients who are covered by a governmental plan (e.g. Medicare/Medicaid/Tricare) must have technical charges billed to the hospital/client as these services are reimbursed to the facility under the prospective payment system (PPS) or outpatient prospective payment system (OPPS).
For questions about your client invoice,
call 214-237-1665 or 800-654-1888 ext. 1665,
M-F 8:00 a.m. - 4:30 p.m. C.S.T.
If the patient is self pay, please check "PATIENT" under the "BILL TO" section of the requisition or online order form. Please be sure to provide complete patient name, address, city, state, ZIP code, and telephone number. For uninsured patients, please contact your sales or service representative to learn about our Uninsured Billing Policy.
ProPath is required to bill Medicare for all patients enrolled under Part B, when Medicare covers the testing services performed. For tests not covered by Medicare (e.g., some routine Pap screening), an ABN (Advanced Beneficiary Notice) must be completed by the physician's office and signed by the Medicare patient.
ProPath will also bill Medicaid as required.
The minimum information required for billing Medicare and Medicaid is as follows:
- Patient Name
- Patient Address
- Patient Date of Birth
- Patient Sex
- Medicare/Medicaid Number
- Referring Physician
- Referring Address
- ICD-10 Code
- NPI Number
ProPath is contracted with many insurance carriers. Please fill in the appropriate information on the test requisition (i.e., HMO, PPO, Medicare, etc.).
A copy of your office face sheet and the front and back of the patient's insurance card will ensure accurate billing.
NOTE: Due to the fact that most insurance carriers allow only a short filing deadline, sufficient data to properly bill the third party carrier is imperative. ProPath will attempt to contact the physician's office for any missing information. If unsuccessful, the patient will be billed directly.
ProPath accepts VISA and Mastercard, checks and ACH (wired) payments. Please be sure to reference your Invoice Number when making a payment.
Payments by credit card can be made by calling our Client Billing office at (214) 237-1665 or (800) 654-1888 and ask for Client Billing.
Terms are Net 30 days.