Billing & Payment Resources
Southwest Labs is committed to transparent, accurate billing built on individualized test ordering and clear medical necessity documentation. Explore our billing approach and payer resources below.
Commitment to Compliance
At Southwest Labs, compliance is fundamental to every aspect of our operations. We maintain a comprehensive compliance program designed to ensure adherence to all applicable federal and state regulations, including Centers for Medicare & Medicaid Services (CMS) requirements, Clinical Laboratory Improvement Amendments (CLIA) standards, and College of American Pathologists (CAP) accreditation requirements.
Our compliance program is built on the principles of medical necessity, individualized test ordering, accurate coding and billing, complete documentation, and ongoing quality assurance through routine internal audits and continuous monitoring. We are committed to maintaining the highest standards of integrity, transparency, and regulatory compliance in every service we provide.
Clinical testing decisions are made solely by the ordering provider based on each patient's individual medical needs. Southwest Labs supports providers by delivering accurate laboratory services, educational resources, and clear billing practices while ensuring all testing is performed in accordance with applicable regulatory and payer requirements. We do not direct or influence clinical decision-making or test selection.
Through a culture of accountability, education, and continuous improvement, Southwest Labs is dedicated to helping providers deliver high-quality patient care while maintaining compliance with all applicable healthcare laws, regulations, and industry best practices.
Our billing approach
At Southwest Labs, we are committed to accurate, compliant, and transparent billing. Our billing practices follow applicable laws and regulations, payer policies, contractual requirements, and established internal controls. We routinely review billing processes to promote accurate claim submission, appropriate reimbursement, and consistency across payers while maintaining the highest standards of compliance and integrity.
Our Billing Standard
Federal fee schedule and coverage guidance relevant to your bill.
Payer policy portals
Coverage policies vary by payer and jurisdiction. Use each payer's own portal to find the policy that applies to your patient.
Provider Education Medical Necessity
Clinical Resources Molecular Testing Sample Pt Scenarios
References
- https://onbaseext.phs.org/PEL/DisplayDocument?ContentID=OB_000000028908
- https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=34645#:~:text=Presumptive/Qualitative%20Drug%20Testing%20(hereafter%20called%20%22presumptive%22%20UDT)%20-%20Covered%20when
- https://www.uhcprovider.com/content/dam/provider/docs/public/policies/medicaid-comm-plan-reimbursement/UHCCP-Drug-Testing-Policy.pdf#:~:text=Definitive%20urine%20drug%20test%20(UDT)%20reports%20the%20results%20of%20drugs
- https://www.aetna.com/cpb/medical/data/900_999/0965.html#:~:text=This%20Clinical%20Policy%20Bulletin%20addresses%20drug%20testing%20in%20pain%20management
- https://www.molinahealthcare.com/-/media/Molina/PublicWebsite/PDF/Providers/common/Payment-Integrity/PI-Payment-Policy-33-Outpatient-Definitive-Drug-Testing_Medicaid-Medicare.pdf#:~:text=Outpatient%20definitive%20drug%20testing%20is%20considered%20medically%20necessary%20for%20Members
- https://static.cigna.com/assets/chcp/pdf/coveragePolicies/medical/mm_0513_coveragepositioncriteria_drug_test.pdf#:~:text=Drug%20testing%20is%20used%20as%20a%20diagnostic%20and%20therapeutic%20tool
- https://www.bcbsnm.com/content/dam/hcsc/docs/provider/nm/udt_documentation_guidelines.pdf#:~:text=Blue%20Cross%20and%20Blue%20Shield%20of%20New%20Mexico%20(BCBSNM)%20processes
Got questions? Contact us.
- (505) 609-5227
- 1 (855)875-9796 (fax)
- billingteam@southwestlab.com
- 4261 Balloon Park Rd, NE