Billing

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.

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.