How to identify lab service charges belong to insurance company?

[Iris Wang]

I received an invoice from M Health. The letter asked me to review the bill and contact them regarding any charges that should be billed to the subject's insurance and not to the research study.  Every participant has different insurance policy,  how do I know which procedure is covered by his/her insurance?  I just wondering how does everyone else handle this problem?   

[Seth Goldberg]

The party that pays the procedure must be clearly stated in the billing grid submitted to the IRB before the study started. You can look it up in TASCS or now OnCore depending on where it originated. If the procedure at the specific milestone is Ins in TASCS or OnCore, the procedure is billed to Insurance or the Patient themselves if they have no coverage. If it's an R, then it's research items and paid by the study via EFS. O was also used in TASCS to designate procedures performed by study staff that would be paid as labor to a Nurse, CRA, or PI.

There are some items, usually specifically called out in the invoiceables table for the study that are normally paid for by Insurance but should be paid for by the study, and usually invoiced by us to the sponsor in the event they occur outside of the normal Standard of Care schedule.