CommercialCoverageHigh impact
Hospital Laboratory Pass Through Billing
Blue Cross Blue Shield of Rhode Island·RI·Physician / Facility
Effective date
Feb 1, 2020
We identified it
Jun 20, 2026
Summary
Effective February 1, 2020, BCBSRI prohibits hospitals from billing for laboratory services through pass-through billing arrangements. Any claims identified as pass-through billing will be denied as provider liability with no reimbursement to hospitals or members.
Action Required
Immediately: Hospital billing teams must stop submitting laboratory claims using pass-through billing arrangements to BCBSRI. Verify all laboratory claims are for services directly performed by the hospital, not third-party labs. Update billing workflows to flag potential pass-through scenarios. Claims submitted as pass-through billing will be denied with provider liability.