Billing Information

Pacific Toxicology Laboratories can bill government providers for covered services. Please provide the following billing information along with the specimen:

1. patient's name & address
2. sex & date of birth
3. written diagnosis or ICD-10-CM code
4. HIC (9 Numerics and 1-2 Alphanumerics/or copy of card)
5. insurance co. name & address
6. ins, co. phone number
7. physician's state license number, NPI number, and Pecos registered
8. physician signature

Workers Compensation claims will be filed if all the required information is provided at the time the specimen is submitted for analysis.

1. patient's name & address
2. patient's phone number
3. date of birth
4. date of injury
5. social security number
6. driver's license (state, number and exp. date)
7. written diagnosis or ICD-10-CM code
8. attorney's name & address
9. attorney's phone number
10. insurance co. & address
11. ins. co. phone number
12. ID & Group number (photocopy of ins. ID card if available)
13. adjuster & claim number (if available)
14. Approve RFA

The patient or their attorney may be billed directly in cases of personal injury, however, all tests must be ordered by a physician. In addition, we must have a signed lien in these cases. We recommend personal injury cases be prepaid at the time the specimens are submitted for testing. Failure to provide any of the following information may delay testing:

1. patient's name & address
2. patient's phone number
3. date of birth
4. social security number
5. driver's license (state, number and exp. date)
6. date of injury
7. written diagnosis or ICD-10-CM code
8. attorney's name & address
9. attorney's phone number
10. court name & address
11. case name & number (if available)
12. insurance co. name & address (if available)

Consultation, depositions, and special handling regarding specimen preparation, logistics, research, special reports, etc. will be billed at a predetermined hourly rate, plus expenses independent of any test analysis fees. This fee must be paid before any action will be initiated. There is a one-hour minimum charge and time extending beyond that will be billed and itemized in fifteen-minute segments.