Independent Clinical Laboratory
Whenever outside lab services are required, refer members to a participating independent clinical lab. Quest Diagnostics is the preferred statewide clinical lab provider for all products. It offers a broad array of lab services to help you meet your clinical needs for patient management and tools to improve office efficiency. Check the applicable network Provider Directory for a listing of other participating labs. For questions, call the Provider Contact Center.
The following are specific lab requirements for our networks.
Preferred Patient Care (BlueChoice)
In addition to Quest Diagnostics, there are some small local, participating labs in the PPC network. Members receive the highest benefit levels when using Quest Diagnostics or other in-network labs. Members may incur significantly more out-of-pocket costs when a non-participating lab is used and they will be responsible for paying the lab directly.
NetworkBlue (BlueOptions) and Medicare Advantage PPO (BlueMedicare PPO)
BlueOptions and BlueMedicare PPO members receive the highest benefit levels when using Quest Diagnostics or other in-network labs. Members may incur significantly more out-of-pocket costs when a non-participating lab is used.
Health Options (BlueCare) and Medicare Advantage HMO (BlueMedicare HMO)
There is no out-of-network lab benefit for BlueCare and BlueMedicare HMO members. Use Quest Diagnostics for your members’ lab needs. If Quest Diagnostics does not offer the service requested, call (800) 955-5692 to locate another lab in the Health Options network. Authorization must be obtained for non-emergency out-of-network lab services.
Lab services are managed under a preferred arrangement with Quest Diagnostics. There is no coverage for lab services rendered by a non-participating lab and the BlueSelect member will be responsible for 100 percent of the provider’s billed charges.
In addition to Quest Diagnostics, there are some small local, participating labs in the Traditional network.
To Contact Quest Diagnostics
Call: 1-866-MYQUEST (1-866-697-8378)
Visit Quest Diagnostics' website for patient service center locations, and to order lab tests and view results through the Quest Diagnostics Care360 Physician Portal.
Ordering physicians may also schedule appointments on behalf of the member by calling Quest Diagnostics or accessing the website, www.questdiagnostics.com/appointment. While appointments are not required, they may ease patient wait times associated with testing and improve compliance.
Lab Requisition Form
Before referring a member to a participating lab, physicians should complete the appropriate lab requisition form and include the following information:
- The specific test code for each test ordered
- Any and all applicable diagnosis code(s)