Author Topic: Can a non-credentialed provider order and bill for labs?  (Read 579 times)


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Can a non-credentialed provider order and bill for labs?
« on: August 23, 2017, 02:05:06 PM »
I am completing my practicum and I have been tasked with finding out the answer to the following question:

If a physician is licensed in MA, can he order labs and have labs billed to an insurance company if he is not yet credentialed with that insurance company?

Any assistance would be great.
Thank you,


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Re: Can a non-credentialed provider order and bill for labs?
« Reply #1 on: August 24, 2017, 08:33:17 AM »
I don't mind helping but I don't like just answering a question for you as that doesn't really help you.  However I do appreciate you being honest about the fact that it is a question. 

Honestly this question raises questions for me.  What type of physician?  MD, DO?  This matters because the physician must be someone who it is within their scope of practice to order the labs (which also they don't specify as to what type of labs, so I'm assuming blood tests of some sort).

What insurance company?  This matters because Medicare requires that any ordering physician be in the PECOS system.  Commercial insurance plans all have their own plan provisions.

So in my opinion there is not a simple answer to this question.  I hope I've at least given you some information that will help you determine what they are looking for in the answer.

Personally I find that many of the tests given do not match real world situations.  JMHO

Good luck!
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