Laboratory Resources
Billing
Our billing services are provided by APS Medical Billing.
Representatives assist patients and providers with questions regarding general billing processes, invoicing options, payment steps, and specific invoice inquiries.
For price inquiries, please contact Client Services at 1.800.628.6816.
Laboratory Resources
Contact APS Medical Billing
Local: 1.419.866.1804
Representatives available from 9 a.m. to 5 p.m. EST, Monday through Friday
Toll-free: 1.800.365.3744
Federal Tax Identification Number:
34-0714585 | Form W-9
Dun & Bradstreet (DUNS) Number:
017730458
Billing Information
Accepted Insurance & Managed Care Plans
This list is subject to change. Coverage limitations are dependent on individual group contracts.
For questions about insurance coverage and specific plan products, please contact the insurance carrier directly.
| wdt_ID | Provider | Plan | Type |
|---|---|---|---|
| 1 | AARP through UnitedHealthcare | MedicareComplete | Medicare HMO |
| 2 | AARP through UnitedHealthcare | Essential | Medicare HMO |
| 3 | AARP through UnitedHealthcare | Choice | Medicare PPO |
| 4 | AARP through UnitedHealthcare | Plus | Medicare HMO-POS |
| 5 | Aetna | Health Network Option | HMO |
| 6 | Aetna | Medicare Plan | Medicare PPO, Medicare HMO |
| 7 | Aetna | National Advantage Program (NAP) | Traditional |
| 8 | Aetna | Signature Administrators | PPO |
| 9 | Aetna | USHC - Elect Choice | EPO |
| 10 | Aetna | USHC - Managed Choice | POS |
| 11 | Aetna | USHC - Open Choice | PPO |
| 12 | Aetna | USHC - Quality Point of Service | POS |
| 13 | Aetna | USHC - Select Choice | HMO |
| 14 | Anthem Blue Cross Blue Shield (BCBS) | Blue Access | PPO |
| 15 | Anthem Blue Cross Blue Shield (BCBS) | Blue Access - Preferred Primary | HMO |
| 16 | Anthem Blue Cross Blue Shield (BCBS) | Blue Access - Preferred Primary Plus | POS |
| 17 | Anthem Blue Cross Blue Shield (BCBS) | Blue Access - Traditional | Traditional |
| 18 | Anthem Blue Cross Blue Shield (BCBS) | MediBlue Access, Core, Enhanced | Medicare PPO |
| 19 | Anthem Blue Cross Blue Shield (BCBS) | MediBlue Access, Core, Enhanced - Dual Advantage | Dual Eligible |
| 20 | Anthem Blue Cross Blue Shield (BCBS) | MediBlue Access, Core, Enhanced - Essential | Medicare HMO |
| 21 | Anthem Blue Cross Blue Shield (BCBS) | MediBlue Access, Core, Enhanced - Plus | Medicare HMO |
| 22 | AultCare | Aultman Employee Network | PPO |
| 23 | AultCare | Exchange | HIX/Exchange |
| 24 | AultCare | Health Plan | HMO, PPO |
| 25 | AultCare | Premier Select | HIX/Exchange |
| 26 | AultCare | Select | HIX/Exchange |
| 27 | AultCare | Select Network | HIX/Exchange |
| 28 | AultCare | TPA | PPO |
| 29 | Beech Street | Beech Street | PPO |
| 30 | Buckeye | Advantage | Medicare HMO SNP |
| 31 | Buckeye | Community Health Plan | Medicaid HMO |
| 32 | Buckeye | Community Health Plan - MyCare Ohio | Dual Eligible |
| 33 | CareSource | CareSource | Medicaid HMO |
| 34 | CareSource | MyCare Ohio | Dual Eligible |
| 35 | ChoiceCare | ChoiceCare, ChoiceCare+ Network | PPO, POS, Open Access |
| 36 | Cigna | Healthcare of Ohio | HMO, HMO Open Access, Open Access, Open Access Plus, POS, PPO, PPO Open Access |
| 37 | Cigna | Choice Fund | Open Access Plus |
| 38 | Cigna | Local Plus | Open Access |
| 39 | Cigna | Qualcare Open Access Plus Plan | Open Access |
| 40 | Cleveland Clinic | Employee Health Plan | Direct Employer |
| 41 | First Health | also known as Coventry Health Care, Inc., Affordable, Healthcare Compare | PPO, Workers Compensation |
| 42 | FrontPath | *Pre-certification is required for coverage.* | PPO |
| 43 | Gateway Health Plan - Medicare Assured | Choice & Prime | Medicare HMO |
| 44 | Gateway Health Plan - Medicare Assured | Diamond & Ruby | Medicare HMO D-SNP |
| 45 | Gateway Health Plan - Medicare Assured | Select Gold & Platinum | Medicare HMO C-SNP |
| 46 | Great West Healthcare (GWH) | Cigna | Open Access Plus |
| 47 | HealthLink, Inc. | HealthLink, Inc. | Open Access, PPO |
| 48 | HealthSmart Preferred Network, Inc. | HealthSmart Preferred Network, Inc. | PPO |
| 49 | Health Net Federal Services Tricare | Extra | PPO |
| 50 | Health Net Federal Services Tricare | Prime | HMO |
| 51 | Health Net Federal Services Tricare | Standard | Traditional |
| 52 | The Health Plan | The Health Plan | EPO, HMO, POS, PPO |
| 53 | The Health Plan | SecureCare | Medicare HMO |
| 54 | The Health Plan | SecureChoice | Medicare PPO |
| 55 | Humana | Choice Medicare Advantage | Medicare PPO |
| 56 | Humana | Gold Plus HMO | Medicare HMO |
| 57 | Humana | Gold Choice | Medicare Private Fee-For-Service (PFFS) |
| 58 | Interplan Health Group | HealthSmart Network | PPO |
| 59 | Medical Mutual | HealthSpan Federal Employees | Federal Employees Health Benefits Program (FEHB) |
| 60 | Medical Mutual | Medicare Advantage - Access PPO | Medicare Advantage PPO |
| 61 | Medical Mutual | Medicare Advantage - Choice HMO | Medicare Advantage HMO |
| 62 | Medical Mutual | Medicare Advantage - Classic HMO | Medicare Advantage HMO |
| 63 | Medical Mutual | Medicare Advantage - Plus HMO | Medicare Advantage HMO |
| 64 | Medical Mutual | Medicare Advantage - Preferred PPO | Medicare Advantage PPO |
| 65 | Medical Mutual | Medicare Advantage - Premium PPO | Medicare Advantage PPO |
| 66 | Medical Mutual | Medicare Advantage - Secure HMO | Medicare Advantage HMO |
| 67 | Medical Mutual | Medicare Advantage - Select PPO | Medicare Advantage PPO |
| 68 | Medical Mutual | Medicare Advantage - Signature HMO | Medicare Advantage HMO |
| 69 | Medical Mutual | SuperMed | PPO |
| 70 | Medical Mutual | SuperMed - Classic | HMO |
| 71 | Medical Mutual | SuperMed - HMO | POS |
| 72 | Medical Mutual | SuperMed - Preferred | PPO |
| 73 | Molina HealthCare Medicaid | Molina HealthCare Medicaid | Medicaid HMO |
| 74 | Multiplan & Multiplan Limited Benefit Plan | Multiplan & Multiplan Limited Benefit Plan | PPO |
| 75 | Ohio Health Choice Plan | Preferred Health Choice | PPO |
| 76 | Ohio Health Choice Plan | Preferred Health Choice Plus | EPO |
| 77 | Ohio Medical Aid Services (OMAS) | Amish Church Fund, Groups I, II, & III | Church Fund, Full Service |
| 78 | Ohio Medical Aid Services (OMAS) | Ohio Amish Worker’s Accident Aid | Church Fund, Full Service |
| 79 | Ohio Medical Aid Services (OMAS) | Ohio Crippled Children’s Fund | Church Fund, Full Service |
| 80 | Ohio PPO Connect | Ohio PPO Connect | PPO |
| 81 | Ohio Preferred Network | Ohio Preferred Network | PPO |
| 82 | Oscar Health | Oscar Health | EPO |
| 83 | Paramount | Advantage Elite | Medicaid HMO |
| 84 | Paramount | Enhanced: Medical & Drug | Medicaid HMO |
| 85 | Paramount | Enhanced: Medical Only | Medicaid HMO |
| 86 | Paramount | Standard: Medical & Drug | Medicaid HMO |
| 87 | Private HealthCare Systems (PHCS) | Private HealthCare Systems (PHCS) | PPO |
| 88 | SummaCare | Mercy Choice | HMO, POS, PPO |
| 89 | SummaCare | Premier & Premier Tiered | HMO, PPO |
| 90 | SummaCare | Prime & Prime Tiered | PPO, EPO |
| 91 | SummaCare | PrimeTime Health Plan | Medicare HMO-POS |
| 92 | Three Rivers Provider Network | Three Rivers Provider Network | PPO |
| 93 | UnitedHealthcare | Community Plan | Medicaid HMO |
| 94 | UnitedHealthcare | Community Plan MyCare Ohio | Dual Eligible |
| 95 | UnitedHealthcare | Dual Complete SNP | Medicare HMO SNP |
| 96 | UnitedHealthcare | Medicare Advantage | Medicare HMO, Medicare PPO |
| 97 | UnitedHealthcare | MedicareComplete | Medicare HMO |
| 98 | UnitedHealthcare | MedicareComplete Choice | Medicare PPO |
| 99 | UnitedHealthcare | MedicareComplete Essential | Medicare HMO |
| 100 | UnitedHealthcare of Ohio | Choice | EPO |
| 101 | UnitedHealthcare of Ohio | Choice Plus | POS |
| 102 | UnitedHealthcare of Ohio | Choice / Choice Plus | HMO |
| 103 | UnitedHealthcare of Ohio | Options | PPO |
| 104 | UnitedHealthcare of Ohio | Pinnacle | PPO |
| 105 | UnitedHealthcare of Ohio | Select | EPO, HMO, PPO |
| 106 | UnitedHealthcare of Ohio | Select Plus | POS |
| 107 | UPMC Health Plan | Advantage UPMC Employee Plan | EPO, PPO |
| 108 | UPMC Health Plan | Business Advantage | EPO, HMO, PPO |
| 109 | UPMC Health Plan | Consumer Advantage | EPO, PPO |
| 110 | UPMC Health Plan | HealthyU | EPO, PPO |
| 111 | UPMC Health Plan | Individual Advantage | HMO, Exchange |
| 112 | UPMC Health Plan | Inside Advantage | PPO |
| 113 | UPMC Health Plan | MyCare Advantage | EPO, PPO |
| 114 | UPMC Health Plan | Pitt Panther Gold | Student Sports-Related |
| 115 | UPMC Health Plan | Small Business Advantage | EPO, HMO, PPO |
| 116 | UPMC Health Plan | UPMC for Life HMO | Medicare Advantage HMO |
| 117 | UPMC Health Plan | UPMC for Life PPO | Medicare PPO |
| 118 | USA Managed Care Organization | USA Managed Care Organization | PPO |
| Provider | Plan | Type |
Client Billing
Clients receive monthly itemized invoices within the first week of every month. Payment terms are net 30 days.
Invoices can be accessed by contacting [email protected], emailed as a PDF attachment, or mailed to the client’s address. We require that any notifications, changes, or errors be reported within 30 days of the invoice date.
For client bill payments using a credit card, please call 1.866.587.6681.
All invoices include:
- Patient name
- Date of service
- Test(s) performed
- Accession number
- CPT code
- Test price
- Purchase order (if requested)
- Client MRN (if requested)
For any legacy-related invoices from before April 1, 2023, please contact [email protected].
Third-Party Billing
At the client’s request, we can submit payment claims to government, private, or individual payers. All Medicare plans are accepted in addition to third-party commercial insurers contracted with Cleveland Clinic Laboratories. Any third-party insurance that is not contracted with Cleveland Clinic Laboratories will be billed back to the client.
Medicare requires all providers who order or refer items for their beneficiaries to be enrolled in the Medicare program. Only State of Ohio Medicaid plans can be billed by Cleveland Clinic Laboratories.
Patients are responsible for annual deductibles, co-payments, and any balance not covered by their insurance plan.
We accept assignments on Medicare and Ohio Medicaid billing.
Third-Party Billing Requirements
Incorrect or missing information regarding a patient, their diagnosis, and insurance are leading causes of lost or delayed reimbursement. To ensure that claims are submitted to the appropriate payer, please provide the following information:
Patient Demographics
- Full Name
- Date of Birth
- SSN
- Gender
- Full Address
- Phone Number
A copy (front and back) of each of the patient’s insurance cards
Ordering & Referring Physician Information
- Full Name
- NPI
- SSN
- Phone Number
- Email Address
An appropriate ICD-10 diagnosis code for each ordered test
If the required information is missing, the client assumes responsibility and will be billed for all services.
Patient Billing
Patients may request services that are not covered by their benefits. Such services may be provided as long as the patient has completed an Advance Beneficiary Notice (ABN) and agreed to pay for them.
Please advise patients that they will receive a bill for laboratory services from Cleveland Clinic Laboratories and that they are solely responsible for these charges. Payment is due upon receipt of their bill. Checks and credit cards are acceptable forms of payment.
Pay Your Bill Online
Patients can pay their bills online via the APS Payment Portal.
Please have your statement available. You will be prompted to enter your account number, last name, and date of birth.
CPT Codes
Current Procedural Terminology (CPT) codes are listed in our Test Directory to assist clients with billing.
For tests that involve several components, our Test Directory provides a comprehensive list of CPT codes for all of the possible testing components; however, only a subset of component tests may be performed on your specimen. All clients should verify the accuracy of any codes that are listed.
Because CPT codes are subject to change at any time, it is the responsibility of the client to verify the accuracy of the test(s) performed. Clients are encouraged to consult the CPT Coding Manual published by the American Medical Association and to address questions regarding the use of codes according to their local Medicare carrier.
Cleveland Clinic Laboratories does not assume responsibility for billing errors due to reliance on CPT codes listed in the Test Directory.
Credits & Cancellations
Cleveland Clinic Laboratories reserves the right to review credit reports from reporting agencies such as Equifax, TransUnion, and Experian.
All invoices are due in full upon receipt and must be paid within 30 days from the date billed.
All claims, requests for adjustments, or notifications of errors must be made within 30 days of the invoice date. If nothing is communicated within the 30-day time frame, charges are considered to be accepted.
Charges unpaid after 120 days are subject to collection. The purchaser will assume all collection expenses, attorney fees, and court costs.
Fee Changes
Fees are subject to change without notification.
Advance Beneficiary Notice
The ordering physician is responsible for ensuring that any laboratory procedures requested are medically necessary, as determined by federal guidelines.
A completed Advance Beneficiary Notice (ABN) form signed by the patient must accompany specimens that are expected to be denied by Medicare.
Printed copies can be ordered online from the Supply Storefront or downloaded as a fillable PDF.