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| Phone: | (800) 343-4407 |
| Fax: | (800) 845-6167 |
| Hours of Operation: | Monday -Thursday 7:00am - 5:00pm CST, Friday 7:00am - 4:00pm CST |
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Client Billing
Esoterix will submit invoices at the beginning of each month for all laboratory tests that were resulted during the previous month. The invoices include a payment coupon and we enclose a payment envelope for your convenience. The payment terms are NET 30 days. Please send client payments to:
Esoterix, Inc.
P. O. Box 8022
Burlington, NC 27216-8022
Third Party Insurance Carriers
Esoterix will bill all third party insurance carriers, including in-network and out-of-network insurance companies. Some out-of-network insurance companies may need to be pre-authorized by the ordering physician. All third party billing information must be included on the test requisition including the following: patient name, date of birth, patient address, insurance name, insurance address, member ID, group number, ordering physician's name, UPIN number, and a diagnosis code(s) for ordering the test.
Patient Billing
Esoterix accepts checks or credit cards (Visa, Mastercard, American Express) from patients requesting direct billing for services performed by our laboratory. The payment terms for patient bills are NET 15 days. Please send patient payments to:
Esoterix, Inc.
P. O. Box 8024
Burlington, NC 27216-8024
Medicaid and Medicare Billing
Esoterix will bill Medicare and Medicaid directly for services rendered, if the ordering physician is eligible for Esoterix to complete the billing. All billing information must be included on the test requisition including the following: patient name, patient address, patient date of birth, Medicare or Medicaid number. Medicare also requires the ordering physician's name and NPI number, and for Medicaid, the referring physician's name and Medicaid provider number. Established diagnoses with related ICD-9 codes and/or signs/symptoms which support medical necessity must be written on the test requisition. If you feel that Medicare may not pay for the ordered test(s), you must inform the patient that Medicare may not cover the test(s) ordered and complete an Advanced Beneficiary Notice of Non Coverage (ABN). The ABN must be signed and dated by the patient prior to the service, and items or services with their estimated prices must be indicated for which Medicare is likely to deny payment.
Esoterix has customized the standard ABN for laboratory services as allowed under CMS requirements. The customized Esoterix ABN contains a list of the most frequently ordered tests that require a completed ABN, as well as the estimated price consistent with the patient fee schedule. Clients are able to use the ABN estimated price to provide patients with an estimated cost. While every effort is made to ensure that the price is accurate, the patient, if Medicare denies payment, may be charged a different amount due to fee adjustments. Clients may also contact Esoterix billing services for an estimated price to provide Medicare patients.
Clients may refer to the Medicare Coding Policy Manual and Change Report for a complete list of National Coverage Determinations (NCDs).
CPT Codes
The Esoterix Directory of Services lists CPT codes to provide guidance. These codes are subject to change on a regular basis and it is the client's responsibility to verify the accuracy of the CPT codes listed. Please refer to the most current version of the CPT coding manual published by the American Medical Association to resolve any issues.
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