Provider FAQs

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:

https://pecos.cms.hhs.gov/pecos/login.do#headingLv1

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.

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When Medicare covers the testing services performed, ProPath is required to bill Medicare for all patients enrolled under Part B. 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

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.

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 sent a bill 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, Fax 214.237.1865
M-F 8:00 a.m. – 4:30 p.m. C.S.T.

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, 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.

We have provided digital copies of some requisitions for your convenience, print out or request a copy from ProPath .

If you have not previously submitted samples to our lab, please include all contact information for your institution and the ordering physician.

Please select and click from the list below for test requisition forms:

If additional information is needed, please see our Test Directory.

For information on other requisitions, please contact Customer Service at: 214.638.2000 or 800.258.1253.

1. Complete IHC/In Situ Requisition.
   a. Circle stains or clearly write name of stain at top of the requisition.
   b. Check “Staining Only” as Type of Service Desired.
2. Include paraffin block(s).
3. Provide patient billing information (if applicable).
4. Include a copy of patient report (optional, but it assists in verifying patient information).
5. If sending unstained slides instead of a paraffin block(s):
   a. Sections must be on Plus or silane-treated slides.
   b. Place section either at the bottom or the top third so ProPath can add our control tissue to your slide.
   c. Unstained slides must be either completely air dried or oven dried. If oven dried, place the slide in the rack so that the melted paraffin does not run into the area where ProPath will add the control.
   d. ProPath would like to stain two slides for H&E to keep in our file. Additional slides are also very helpful in cases where the initial stain was unsatisfactory (due to tissue washing off slide, etc).

Examples: If you request one stain, send us four unstained slides minimum. If you request three stains, send us six unstained slides minimum.

NOTE: In-situ hybridization stains require two additional slides for controls. Include one slide for RNA negative control, one slide for RNA positive control (to verify integrity of RNA in the specimen), and one slide for probe positive control. Please note all FISH orders require a ProPath interpretation.

Example: If you request an EBV (EBER) stain, send us six unstained slides minimum. If you request the full HPV Panel, please send us a minimum of 8 unstained slides.

ProPath will return any unused slides.

1. Complete IHC/In Situ Hybridization Requisition.
   a. Check “Staining with Interpretation and Report on Client Requested Stains”, Consult on Submitted Materials (appropriate stains will be selected by ProPath Pathologists as needed)” or “Basic Breast Panel w/Interpretation” as Type of Service Desired.
2. Include paraffin block(s).
3. Provide representative slides on the case; (H&E’s, special and IHC slides).NOTE: An H&E slide is strongly encouraged, as it expedites ordering the stains and improves turnaround time. These H&E slides and all other client slides are returned.
   
4. Provide a copy of patient report/history.
5. Provide patient billing information (if applicable).
6. If sending unstained slides instead of paraffin block(s):
   a. Sections must be on Plus or silane treated slides.
   b. Place section either at the bottom or the top third so ProPath can add our control tissue to your slide.
   c. Unstained slides must be either completely air dried or oven dried. If oven dried, place the slide in the rack so that the melted paraffin does not run into the area where ProPath will add the control.
   d. ProPath runs one negative slide for each case and would like to stain two slides for H&E to keep in our file. Additional slides are also very helpful in cases where the initial stain was unsatisfactory (due to tissue washing off slide, etc). Examples: If you request one stain, send us four unstained slides minimum. If you request three stains, send us six unstained slides minimum.
7. Please use the Dermatopathology Consult Requisition for all dermatology-based cases.

ProPath works to be a participating provider with insurance companies.

Please see your sales or service representative for a complete insurance list.