STEP 8:
Billing
Select your testing type?
How to apply
How to get ready for testing
How to conduct tests
What to do after testing
BillingCollection sites will not be responsible for test processing costs.
However, sites will be responsible for costs of shipping and other equipment for the collection process (e.g., PPE).
Sites have 2 options to cover the cost of the test:
- Direct billing
- Insurance billing
Where the test is covered by the patient’s health coverage (see categories below), the state has contracted with a third-party vendor to submit claims. Therefore, patients will be asked to provide information about their health coverage. Patients without health coverage will be asked to attest that they do not have insurance and provide their State ID or driver’s license number (if applicable).
Note: Patients can take the tests without State IDs, driver’s licenses, or insurance. They can optionally show these items so the State can receive reimbursement from the Federal government.
| Billing type | What it means |
|---|---|
| Direct billing | The state directly bills sites for the cost of each test conducted ($55/test). The state will invoice the site monthly for the tests conducted. Please note, hospitals seeking temporary support to test healthcare workers must set-up direct billing. Note: The current price per test is $55, from collection through processing. Test costs are expected to decrease as the laboratory processes a greater volume of tests. |
| Insurance billing | The state bills an individual’s health insurance for the cost of each test ($55/test). This applies to both patients and employees. Patients and employees will never be balance billed by the state. |
Coverage categories
Category 1: Symptomatic or exposed Individuals
- Federal statutes require coverage:
- No medical/utilization management and no prior authorization requirements
- At any authorized collection site
- Provider reimbursement at negotiated rate or provider’s cash price
Category 2: No symptoms/exposure but enrollee is an “essential worker”
- The emergency regulation:
- Defines who are “essential workers”
- Deems testing for essential workers to be medically necessary in all cases, so no UM or prior authorization required or allowed
- Enrollee must try to get appointment in-network but can go out-of-network if plan does not offer an appointment within 48 hours
Category 3: No symptoms, no exposure, not an “essential worker”
- The emergency regulation:
- Deems testing to be an urgent service when medically necessary for the enrollee
- Allows plans to impose prior authorization requirements
- Requires the enrollee to try to get appointment in-network. But the enrollee can go out-of-network if plan does not offer an appointment within 96 hours
Note: Patients can take the tests without State IDs, driver’s licenses, or insurance. They can optionally show these items so the State can receive reimbursement from the Federal government.