Frequently Asked Questions About Billing
I have insurance. Why are you billing me?
TriCore does not send a bill to patients while insurance claims are being processed. If you have received a bill, it means that TriCore does not have your valid insurance information, or we have received information from your insurance company indicating that you are responsible for a portion of the cost of our services.
Was my insurance billed?
Please read your bill carefully. Your first bill will reflect all of the charges and any insurance payments we have received from your health plan. If you do not see any payments listed from your insurance company, please feel free to contact our Billing Department at 505-247-0244 or 877-267-2428. It’s possible that we did not receive valid insurance information with your lab orders. Please call our Billing Department and provide your current insurance information.
Why isn’t my health plan paying 100 percent?
Individual health plans vary greatly. If you feel that your insurance provider has processed your claim incorrectly and should have paid more, please contact your insurance company for details.
Why won’t you bill my secondary insurance?
TriCore does not automatically file claims with your secondary insurance carrier unless your primary or secondary insurance is considered a government payer (such as Medicare, Medicaid or TriWest).
How do I submit a claim to my secondary insurance?
You should have received an Explanation of Benefits (EOB or Remittance Advice) from your primary insurance provider detailing payment or denial of services rendered. Please mail this form, along with your TriCore bill, to your secondary insurance provider. You can also contact your insurance plan for more specific details.
Why isn’t this test covered?
Individual health plans vary greatly. If you feel your insurance provider has processed your claim incorrectly and should have paid more, please contact your insurer for details.
Why isn’t this covered by Medicare?
Medicare does not provide coverage or has very limited coverage for some routine laboratory tests. In addition, Medicare has strict requirements about the medical necessity of the tests ordered. If your physician has ordered a test that has medical necessity requirements, TriCore or your physician will administer an Advance Beneficiary Notice to you advising that Medicare may not pay for the ordered tests. If you wish to proceed with testing anyway, your signature is required acknowledging financial responsibility for any services for which coverage has been denied.
Can the diagnosis be changed to reflect a “routine” visit so my claim will be paid at 100 percent?
TriCore does not assign diagnoses; this function is performed by your healthcare provider. Providers base their diagnoses on the signs and symptoms that are present during your office visit. If you were scheduled for a routine visit but ended up also discussing other health matters, your insurance company might not consider the visit to have been routine when the time comes to pay your claim. If you have questions about claims payments as they relate to your diagnosis, you should contact your insurance company.
My insurance states they will pay my claim if the CPT code is changed. Can TriCore change the CPT code so my insurance will pay?
TriCore’s medical directors make every effort to correctly interpret CPT codes and apply them appropriately to the methodology of testing performed. TriCore will not change a CPT code to increase reimbursement from insurance carriers.
Why is my bill so much?
While TriCore performs many routine clinical laboratory tests, we also perform many complicated tests, such as genetic testing and molecular diagnostic testing. These complicated tests can be expensive and may not be covered by your insurance plan. If you’re uncertain why your insurance has denied a claim or paid it at a lesser rate, please contact your insurance company.
What is my balance after insurance?
You should have received an Explanation of Benefits (also called an EOB or Remittance Advice) from your insurance carrier advising you of your patient responsibility (for co-insurance, deductible, any denied services or the like). If your bill does not match the amount on your EOB, please contact our Billing Department.
Will TriCore bill non-contracted insurance plans?
TriCore can submit claims to payers we are not contracted with. But if the claim is denied, we expect patients to make full payment.
Why do I have to provide billing information every time I have lab services?
Each visit is treated as a new encounter to ensure that TriCore receives the most current and accurate billing information. This helps to avoid delays in resolving your claim.
Who do I contact to provide updated insurance information?
Please contact a representative in our Billing Department at 505-247-0244 or 877-267-2428.
How often will TriCore bill me?
TriCore will send you a bill approximately once a month once it has been determined that the balance due is your responsibility.
Can I pay my account online?
Yes. TriCore provides the option to make a payment via credit card or e-check. Click here
to make a patient payment.
I don’t have insurance. Does TriCore offer any self-pay discounts?
TriCore does offer an uninsured discount on qualified laboratory tests. Please contact our Billing Department within 14 days after receiving your first bill for additional information.
Can I make payment arrangements?
TriCore will consider payment arrangements on a case-by-case basis. Please contact our Billing Department at 505-247-0244 or 877-267-2428 for more information.
What insurance does TriCore accept?
TriCore accepts nearly all New Mexico insurance plans. Click here
for a list of insurance providers who contract with us.
What are TriCore’s hours of operation and locations?
To find a Patient Care Center, please click here
or call the TriCore Client Services team at 505-938-8922
or toll-free at 800-245-3296
. We’ll give you directions to the center of your choice.
How can I give you feedback on my experience?
You may call Client Services at 505-938-8922
or toll-free at 800-245-3296
, or click on the “Tell Us What You Think
” link on the patient page and complete the online form. If you provide your name and contact information, we’ll respond to your comments.