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To ensure quality of care and allow the member his/her full benefit, Preferred Medical Doctor (PMD) physicians are required to refer laboratory work to a Preferred Medical Lab (PML).
The billing procedures are as follows:
When a PMD physician refers a test to a PML, the PML will bill Blue Cross and Blue Shield of Alabama directly for the test. Benefits will be paid according to the fee schedule for PMLs. When a PMD physician refers a test to a non-PML laboratory, the non-PML laboratory will bill Blue Cross directly for the test. However, benefits will be paid under Major Medical when available and subject to any deductible and copayment amounts.
Clinical laboratories should indicate on their claim the name and NPI number of the physician who referred the test.
Last Updated January 2010