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Billing

­­Athena Diagnostics offers several ordering and billing options to meet the specific needs of each medical practice. The following information can be used to determine the best option for you and your patients.

Direct Institutional Billing

Athena Diagnostics, where possible, will bill a Hospital, Reference Laboratory, and/or a Clinic directly for all services performed for a patient. 

  • For hospital patients who have Medicare and are registered as an inpatient or outpatient, the hospital is required to file claims with Medicare.
  • Athena Diagnostics does not accept Medicaid, however, we do offer a financial assistance program to eligible individuals.

 

CPT Code Recommendations

The CPT codes provided by Athena Diagnostics are based on AMA guidelines and are for informational purposes only. CPT coding is the sole responsibility of the billing party. Please direct any questions regarding coding to the payer being billed.
 

Terms and Conditions

Athena Diagnostics sends invoices every 30 days for testing that has resulted during the previous 30 days. Payment is due upon receipt. Customers who have signed agreements with Athena Diagnostics should follow the terms and conditions outlined in the agreement.
 

Commercial Insurance

Athena Diagnostics accepts all major commercial insurance plans, however, we are not a participating provider in all plans.
 

In-Network Commercial Insurance

Patients with a commercial insurance plan for which Athena Diagnostics is a contracted provider are subject to the deductible, co-insurance or co-pay obligations of their plan. We will bill insurance directly for all of our services with no up-front charges paid to Athena Diagnostics by the patient unless testing is not covered by the contracted payer. We will forward the appropriate notification of obligation to the patient as specified by the Explanation of Benefits (EOB). In all instances, Athena Diagnostics will adhere to the terms of the patient’s individual policy insofar as payments for services are concerned. Patients should check with their local provider for pre-authorization and coverage questions related to our services.  When possible, Athena Diagnostics will provide pre-authorization concierge support for the clinician and patient before the sample is drawn.
 
To find out if an insurance plan is in-network, please contact our reimbursement services department at (800) 394-4493, extension 4.
  • Aetna
  • Cigna
  • Blue Cross Blue Shield of MA
  • Blue Cross Blue Shield of NM
  • Federal Blue Cross Blue Shield
  • Fallon Community Health Plan
  • Harvard Pilgrim Health Care

Out-of-Network Commercial Insurance

Athena Diagnostics accepts all commercial insurance plans, however, we do not have contracts with all commercial insurance plans. We require pre-payment of 20% (up to $1,000) per requisition for out-of-network insurances.  We will file claims and appeals with a patient's insurance plan. Athena Diagnostics will bill the patient for any charges not paid by the insurance. Athena Diagnostics will refund the patient any amount received in excess of our total billed charges or in excess of the total amount due on the EOB. Athena Diagnostics offers programs designed to assist patients in meeting their financial obligations for testing performed at Athena. Visit www.AccessAthena.com/PPP to find out what options are available in your state.

Blue Cross and Blue Shield

Athena Diagnostics is in-network with BCBS of MA and BCBS of NM.  For BCBS members of other states, we require 20% (up to $1,000) per requisition pre-payment.1 Because many BCBS plans send payment directly to their members, Athena Diagnostics also requires a credit card authorization for the remaining amount of the test at the time of services. This authorization will be used to charge the credit card the amount BCBS has paid the member directly, once that amount has been determined, based upon Athena’s receipt of the Explanation of Benefits (EOB) from either BCBS or the patient. In the event the EOB is not provided to Athena within 15 days of request, the credit card will be charged the remaining amount of the test.

Pre-payment is not required if the total amount of the requisition is less than $1,000 or if the order is for an immunology test.
For residents of New York and Florida, if the EOB indicates patient responsibility in excess of the amount authorized, we will bill the patient for the difference.

Government Health Plans

Medicare
For patients who have Medicare and are registered as an inpatient or outpatient, the hospital is required to file claims with Medicare. For all other patients, Athena Diagnostics will submit claims to Medicare Part B (in Massachusetts) for all of our non-molecular tests. Patients with Medicare Part B are not responsible for any payment for non-molecular tests.  An Advance Beneficiary Notice (ABN) is required for molecular tests, as Medicare does not cover molecular testing. A payment authorization of 20% (up to $1,000) per requisition is required, and will only be processed if Medicare adjudicates the claim as denied.
 
Medicare Advantage
A payment authorization of 20% (up to $1,000) per requisition is required. If your insurance carrier pays for services and the Explanation of Benefits (EOB) indicates you are responsible for any applicable deductible, co-payment or coinsurance, if authorization of payment was by credit card, we will only charge the amount indicated on the EOB as your responsibility but not more than the 20% of billed charges or $1,000 per requisition that was authorized.
Pre-payment is not required if the total amount of the requisition is less than $1,000 or if the order is for an immunology test.

Medicaid
Athena Diagnostics is not a participating provider in any Medicaid program, however, we offer active Medicaid members a substantial discount off the regular price for clinical laboratory services. For specific details, please contact our reimbursement services department at (800) 394-4493, extension 4.
Uninsured or Self-Pay Patients

Athena Diagnostics offers a discount to patients who are uninsured or who wish to pay out-of-pocket. For specific details, please contact our reimbursement services department at (800) 394-4493, extension 4. 

Ordering

Athena has made it easy for you to order the testing you need. There are two methods that can be used to order from us outlined below.

  1. Home Blood Draw. A free service that provides a simple way for patients to get their blood drawn and sent directly to Athena using one of our contracted phlebotomy services.2 Simply fill out an AccessAthena Commercial Insurance Requisition Form, and fax it to 866-223-1247. This method guarantees that your specimen will not be routed to another lab, preserving sample integrity and ensuring Athena’s quality.
  2. Partner Hospital/Lab Draw. Patients may have their blood drawn at a local partner hospital laboratory or reference lab.
International ordering is also available.  Please click here for details.

Any questions?
Call Athena's toll free number: 1-800-394-4493 and ask to speak to Reimbursement Services.

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