OSPHL Billing Overview and Updates
In September 2014, the Oregon State Public Health Laboratory (OSPHL) contracted with a billing vendor to bill for communicable disease testing services. The billing vendor began sending charges for services starting with December 2014 dates of service. By increasing our billing capacity, the OSPHL is better securing the financial future of the public health lab to support essential public health functions.
This OSPHL is currently able to receive payments from the following payers:
- First Choice Health Network
- Oregon Medicaid and Coordinated Care Organizations (CCO)
- Exceptions: Health Share Providence and Trillium CCO.
- Washington Medicaid
- Regence Blue Cross
In order for the OSPHL to bill a payer, the patient's insurance information, address, and a diagnosis code for the test must be provided with the laboratory order.
For additional detail about required information when submitting laboratory orders, please review our required fields cheat sheets for the Virology/Immunology Test Request Form (pdf) and the Microbiology Test Request Form (pdf). These versions are intended as a resource and not for specimen submission.
Because only the laboratory that performs the testing may bill Oregon Medicaid for the testing, the OSPHL requires that Oregon Medicaid or CCO information for all patients with this coverage be included with the specimen, unless that client is seeking confidential services due to extenuating circumstances.
Clinic or Laboratory Invoices
Invoices are sent to submitting facilities such as clinics and laboratories via US mail monthly.
If you would like to request adjustments to your invoice, please do so timely using the Claim Adjustment Form included with your invoice. If you have questions about your invoice, please contact the OSPHL billing vendor, Public Consulting Group, Inc. (PCG) at 844-300-5044 (toll free). You may also contact PCG if you would like invoices delivered via secure e-mail rather than US mail.
Information about laboratory fees for testing is provided on the OSPHL Submitter Fee Schedule (pdf).
Public agencies and private non-profit agencies may apply for waived or reduced testing fees using the OSPHL Reduced Fee Request Template (pdf).
Bills to Patients
The OSPHL does not send bills directly to patients.
A patient's insurer may choose to send information to the patient or the primary insurance holder. A 2015 Oregon law allows insured patients (including minors) the right to have Protected Health Information (PHI) mailed directly to their address rather than to the primary insured on the plan. The Oregon Division of FInancial Regulation provides more information about this patient's right to privacy and how to request this modification to mail delivery from the insurance plan.
Claims Sent to Payers
Claims are sent to payers weekly.
If you have specific questions about your invoice, please contact the OSPHL billing vendor, Public Consulting Group, Inc. (PCG) at 844-300-5044 (toll free).
If your questions have not been answered by viewing the materials above, please contact Sarah Humphrey, OSPHL Client Services Coordinator at 503-693-4100 or firstname.lastname@example.org.
Updated October 2017