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Guarantor/Guardian Information Verification

I. PRINCIPLE:

United Clinical Laboratories (UCL) requires that guarantor and guardian information existing in the LIS be verified by the person responsible for entering orders, at the time of order entry.

II. PROCEDURE:

  1. Rules for guarantor information verification:
    The guarantor is the person or legal entity that is fiscally responsible for paying the patient’s medical bills. When billing insurance (Bill To: Ins) Guarantor information is required.
    1. Billing a third party payor (Bill To: Ins):
      1. Patient specimen collected at non-UCL site:
        If the guarantor information is not submitted with specimens collected at non-UCL sites the submitting client must be contacted for this information. The information must be entered in the CLICS database before the ordered tests proceed to billing.
      2. Patient specimen collected at a UCL site:
        Prior to specimen collection and placement of orders, verify ALL guarantor information (name and address) with the patient or, in the case of a child, with their parent or guardian.
    2. Billing an account (Bill To: “Account Name”):
      1. If the guarantor and patient’s primary insurance subscriber names are the same, do a patient search, using this name, in the Patient Registration screen to verify the guarantor address. If this information cannot be verified through the Patient Registration screen, delete the guarantor information from the patient’s demographic profile.
      2. If the guarantor is someone other than the patient or the patient’s primary insurance subscriber and guarantor information has NOT been submitted with the patient request, this information cannot be verified, therefore delete the guarantor information from the demographic profile.
  2. Rules for guardian information verification:
    The guardian is the person (parent or another court-appointed adult) legally responsible for the well-being of the patient, but not necessarily fiscally responsible for the patient’s medical bills.
    Note: When ordering pediatric “Lead, Whole Blood” levels, the guardian information is required. This information must be obtained or verified at the time of specimen collection. If the information is not submitted with specimens collected at a non-UCL facility, the submitting client must be contacted to obtain this information for reporting purposes.

    Regarding testing other than pediatric “Lead, Whole Blood” levels:
    1. If the patient is present, verify ALL guardian information (name and address) with the patient or, in the case of a child, with their parent or guardian.
    2. If the patient is not present and guardian information has NOT been submitted with the patient request, this information cannot be verified, therefore delete the guardian information from the demographic profile.
    1. December 2001 M. English
    2. November 2004 M. English (Revised: II.1. & 2.)

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