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Out-Network Guidelines

RealTime Lab is an Out-Of-Network provider with insurance companies not mentioned above. In these instances, our lab will file your insurance claim electronically for each patient for an additional fee of $30.

If patients are choosing this option, please initial in the appropriate area on the credit card authorization form and include the additional fee in the total price of the test, and provide us the following:

  • Requisition form
  • Copy of the front and back of the insurance card(s)
  • Referring provider’s name and NPI (National Provider Identification Number)
  • ICD-10 (diagnosis) code(s) needs to be obtained from Referring Provider
  • The test price and claim filing fee needs to be pre-paid
  • Copy of Driver’s License for patient(s) 18 yrs. or older, Legal Guardian (younger than 18 yrs.), or primary insured for identification purpose

If patients decide to file a claim to their insurance themselves, the $30.00 filing fee is waved. RealTime Labs will email a superbill / Invoice which includes the itemization of key information noted below, which you will need to file an insurance claim for reimbursement.

  • RealTime Laboratories Inc. NPI (Rendering provider’s National Provider Number)
  • RealTime Laboratories Inc. EIN / Tax ID
  • CPT (Current Procedure codes); the codes outlining the testing procedures utilzied by RealTime Laboratories
  • RealTime Laboratories Address of Operation
  • RealTime Laboratories phone number
  • ICD-10 (diagnosis) code(s) needs to be obtained from Referring Provider
  • Referring Provider’s NPI (National Provider Identification) needs to be obtained from Referring Provider (RTL does not provide referring provider NPI)

In-Network Guidelines

Are you a:

What insurance do you have?

Realtime is a nationwide authorized in-network provider with Medicare but not Medicaid

Patient-General Information

  1. Patients contracted with traditional red, white, and blue Medicare do not need to prepay for testing.
  2. No insurance filing fee will be charged by RealTime Laboratories, Inc.
  3. Medicare Advantage patients will be billed for their finanical responsibility of testing, as outlined on EOB Statement
  4. Procedure codes can be obtained either by calling (972) 492-0419 and following phone tree to Insurance, or by visiting the CPT Code page.
  5. A provider can neither be a self-refering provider nor can they refer family member(s)

Patient Eligibility and Verification Requirements for Medicare and Medicare Advantage:

  • Patient eligibility and verification for Medicare and Medicare Advantage is performed prior to testing the specimen at the lab. The information needed to perform eligibility check is:
  • Name of patient as it appears on Medicare card
  • Traditional Medicare card (Copy of Front and back) of Red, White, and Blue Medicare card
  • Copy of Front and back of Red, White, and Blue Medicare card

Additional Requirements for Medicare Advantage:

  • Traditional Medicare card (Copy of Front and back) of Red, White, and Blue Medicare card
  • Copy of front and back of Medicare Advantage card

Patient Responsibility for Medicare and Medicare Advantage:

ABN Form: Not all Medicare Advantage plans cover the test and Medicare does not cover this test for some ICD-10 Diagnoses; therefore, patients are required to fill out and sign the ABN form acknowledging their responsibility if Medicare does not reimburse the test.

Referring Provider Eligibility Requirements for Medicare and Medicare Advantage:

  • All referring providers (physicians) need to be enrolled as an Ordering and Referring provider with Medicare at PECOS
  • Referring provider(s) need to be enrolled as a Physician with RealTime Laboratories; if you’re a new provider please follow the link below to enroll:
    Provider Information Request page
  • Medicare referring provider eligibility can be checked by referring provider NPI (National provider Identification)
  • Order and Referring – Centers for Medicare & Medicaid Services Data (cms.gov)

Claim Process Check List:

To prevent specimen/test being placed on hold, the following documents/information is required:

  • Requisition form
  • Advance Beneficiary Notice of Non-Coverage Form (ABN) must be completed, signed, and returned to RealTime Laboratories
  • ICD-10 (diagnosis) code(s) needs to be obtained from the referring provider
  • Provider NPI (National Provider Identification Number)
  • Copy of Medicare card
  • Copy of Driver License for patient identification purpose
  • The test does not need to be prepaid, and no insurance filing fee is charged
  • Claim Timely Filing limit for Medicare is 365 days from the date the specimen collected
  • Medicare Advantage:
  • Copy of traditional Medicare card (Red, White, and Blue)
  • Front and Back copy of Medicare Advantage card

Realtime Laboratories Inc. is a Non-Participating, Out of Network Provider with TriCare

Patient General Information:

  •  (Non-Assigned Claim) Patient responsible to pay up front 115% of the TriCare Allowable Charge
  • RealTime Laboratories Inc. is a TriCare Authorized Provider
  • RealTime Laboratories Inc. is out of Network with TriCare
  • Being a Non-participating provider, patient cannot be billed more than 115% of Allowable amount
  • Claim Timely Filing limit for TriCare is 365 days from the date the specimen collected
  • Traditional Medicare IDCopy of Front and back of Red, White, and Blue Medicare card
  • Reimbursement to the patient will come directly from TriCare. For more information, please visit www.mytricare.com/mtc/
  • A provider can neither be a self-refering provider nor can refer family member(s)

Claim Process Requirements:

  • Requisition form
  • Copy of front and back of military IDs must be provided
  • DOB of primary subscriber must be provided
  • Referring provider NPI (National Provider Number)
  • ICD-10 (diagnosis) code(s) needs to be obtained from the referring provider
  • Copy of Driver License for patient identification purpose
  • Copy of Driver’s License for patient 18 yrs. or older, Legal Guardian (younger than 18 yrs.), or primary insured for identification purpose

Claim Process Checklist:

To prevent specimen/test on hold, following documents/information is required:

  • Requisition form
  • If Spouse or Children are tested; copy of front and back of the military IDs must be provided
  • DOB of primary subscriber must be provided
  • Mycotoxin Test needs to be prepaid for 115% of allowable amount
  • Referring provider NPI (National Provider Number)
  • ICD-10 (diagnosis) code(s) needs to be obtained from the referring provider
  • Copy of Driver License for patient identification purpose
  • Copy of Driver’s License for patient 18 yrs. or older, Legal Guardian (younger than 18 yrs.), or primary insured for identification purpose

Realtime Laboratories is a BlueCross BlueShield of TX in-network provider with:

PPO (Preferred Provider Organization)
Blue Essentials & Blue High Performance
HMO (Health Management Organization)

To find out if your claim will be considered in-network, please contact your insurance and give them our NPI 1093099558.

Patient-General Information

  • Patients contracted with BCBSTX do not need to prepay for testing.
  • No insurance filing fee will be charged by RealTime Laboratories, Inc.
  • If any service does require precertification, it is the member’s responsibility to ensure that is in place prior to sending the specimen
  • Claim Timely Filing limit for BCBSTX is 365 days from the date of specimen collected
  • A provider can neither be a self-referring provider nor can refer family member(s)

Claim Submittal Requirement for BCBSTX:

  • Requisition form
  • Copy of front and back BCBSTX card must be provided
  • Referring provider NPI (National Provider Number)
  • ICD-10 (diagnosis) code(s) needs to be obtained from the referring provider
  • Copy of Driver License for patient identification purpose
  • Pre-authorization # needs to be obtained if it is required by your insurance prior to sending the specimen to RealTime Laboratories

Claim Process Checklist:

To prevent specimen/test on hold, following documents/information is required:

  • Requisition form
  • ICD-10 (diagnosis) code(s) needs to be obtained from the referring provider
  • Provider NPI (National Provider Identification Number)
  • Front and back copy of insurance card
  • Copy of Driver License for patient identification purpose
  • Claim Timely Filing limit for BCBSTX is 365 days from the date the specimen collected
  • Pre-authorization # needs to be obtained if it is required by your insurance prior to sending the specimen to RealTime Laboratories
  • RealTime Laboratories will file an in-network claim to BCBSTX. Each patient’s plan determines their individual deductible, out of pocket, and coinsurance amounts. The patient will be billed for any deductible and coinsurance amounts deemed by BCBSTX to be owed by patient.

Realtime Laboratories is a CareFirstMD in-network provider with PPO only
Realtime Laboratories is CareFirstMD Out of Network provider with HMO

Patient-General Information

  • Patients contracted with CareFirstMD do not need to prepay for testing
  • No insurance filing fee will be charged by RealTime Laboratories, Inc.
  • A copy of the front and back of the CareFirst card is required for all patients
  • Provider do not need to be a CareFirst contracted provider for referrals
  • Claim Timely Filing limit for CareFirstMD is 365 days from the date of specimen collected

Claim Submittal Requirements for CareFirstMD:

  • Requisition form
  • Copy of front and back BCBSTX card must be provided
  • Referring provider NPI (National Provider Number)
  • ICD-10 (diagnosis) code(s) needs to be obtained from the referring provider
  • Copy of Driver License for patient identification purpose

Claim Process Checklist:

To prevent specimen/test on hold, following documents/information is required:

  • Requisition form
  • ICD-10 (diagnosis) code(s) needs to be obtained from the referring provider
  • Provider NPI (National Provider Identification)
  • Front and back copy of insurance card
  • Copy of a valid driver license or passport or ID needed for patient identification purpose
  • Copy of Driver’s License for patient 18 yrs. or older, Legal Guardian (younger than 18 yrs.)

What insurance company you are looking for?

Realtime is a nationwide authorized in-network Medicare Provider

Referring Physician Eligibility Requirements:

  • All referring providers need to be enrolled as an Ordering and Referring Provider with PECOS
  • Referring provider needs to be on Realtime referring provider database
  • If provider has submitted an opt-out affidavit to Medicare for their own treatment services; they can still refer lab work to RealTime Laboratories, Inc. to be billed to Medicare; as long as they are PECOS enrolled
  • To become an Ordering and Referring provider a CMS 855O needs to be submitted at CMS 855O | CMS
  • A provider can neither be a self-referring provider nor can refer family member(s)

New Providers

  • New providers please go to PIR (provider information request) to enroll with RTL
  • POC: Sales Onboarding Department-(972)492-0419 Dial (1) – (3)

RealTime Laboratories Inc. is a TriCare Authorized Out of Network Provider

  • RealTime Laboratories Inc. is out of Network with TriCare
  • Being an out of Network provider, test cannot be billed for more than 115% of Allowable Charge
  • Provider needs to provide NPI on the requisition form
  • Provider needs to provide diagnosis code(s) in ICD-10 format
  • Provider needs to provide DOB (date of birth) of the primary subscriber
  • Provider does not need to be in-network to order Mycotoxin test for TriCare patients
  • Mycotoxin Test needs to be prepaid for 115% of allowable amount
  • A provider can neither be a self-referring provider nor can refer family member(s)
  • 115% of Tricare allowable is required in pre-payment, and reimbursement will come to you from your insurance

Realtime Laboratories is a BlueCross BlueShield of TX in-network provider with

  • PPO (Preferred Provider Organization)
  • Blue Essentials & Blue High Performance
  • HMO (Health Management Organization)

Provider-General Information:

  • Providers do not need to be a BCBSTX contracted provider for referrals
  • If a non-contracted provider refers a BCBSTX patient for testing, the test will process in network because RealTime Lab is a preferred BCBSTX Network Provider.
  • Diagnosis codes in ICD-10 format
  • A provider can neither be a self-referring provider nor can they refer family member(s)

Provider Requirements:

  • Referring provider NPI (National Provider Identification)
  • Diagnosis codes in ICD-10 format
  • If any service does require precertification, it is the provider’s responsibility to ensure that is in place prior to specimen being sent to RealTime Laboratories

Realtime Laboratories is CareFirstMD in-network provider with PPO only
Realtime Laboratories is CareFirstMD Out of Network provider with HMO

Provider-General Information:

  • Patients contracted with CareFirstMD do not need to prepay for testing
  • No insurance filing fee will be charged by RealTime Laboratories, Inc.
  • Provider does not need to be a CareFirst contracted provider for referrals
  • If a non-contracted provider refers a CareFirst patient for testing, the test will process in network because RealTime Lab is a CareFirst Network Provider
  • Diagnosis codes in ICD-10 format
  • A provider can neither be a self-referring provider nor can they refer family member(s)

Provider Requirements:

  • Referring provider NPI (National Provider Identification)
  • Diagnosis codes in ICD-10 format
  • If any service does require precertification, it is the provider’s responsibility to ensure that is in place prior to specimen being sent to RealTime Laboratories