Laboratory Services

• Primary Care and OB/GYN Practitioner
• Specialty Care Practitioner
• Preadmission Laboratory Testing
• STAT Laboratory
• Blood Lead Screening
• Unusual Circumstances

In an effort to ensure a consistent level of quality, Gateway has contracted with many participating hospitals and laboratory facilities for outpatient laboratory services. Gateway members are required to have all of their outpatient laboratory work completed through the appropriate contracted lab. Failure to do so could result in non-payment of services. At the time of the initial orientation, the primary care practitioner is required to select a designated laboratory based on the office’s location and the lab used most frequently.

Gateway requires participating practitioners to utilize the member’s specific designated laboratory, based on their primary care practitioner’s selection, for any and all studies required for Gateway members. The designated laboratory is listed on the member’s Gateway ID Card and on Gateway’s On-line Provider Directory located at www.gatewayhealthplan.com. Go to PA Medicaid, and then Find A Provider, or contact Provider Services at 1-800-392-1145.

All outpatient laboratory testing should be ordered with a prescription according to the primary care practitioner’s designated laboratory. Specialists and OB/GYN practitioners can order laboratory testing directly, but must send the member to the member’s primary care practitioner’s designated laboratory listed on the member’s Gateway ID Card with an order for the lab procedure to be performed. Practitioners are encouraged to perform venipuncture in their office and arrange for the specimens to be picked up by the laboratory provider.

Participating primary care practitioners and OB/GYN practitioners who do not perform venipuncture in their office should send members to the appropriate designated laboratory.

Certain tests can be performed in the primary care practitioner’s office and are considered part of the capitation payment rendered by Gateway. Contact your Provider Relations Representative for information on what tests can be performed in the primary care practitioner’s office.

Certain Specialists are permitted to perform lab work in their offices as part of the authorized office visit: Contact your Provider Relations Representative for information on what tests can be performed in the primary care practitioner’s office.

Gateway strongly recommends that preadmission laboratory testing be completed by the practitioner through the member’s designated laboratory. However, if it is not possible to utilize the designated laboratory, testing can be completed at the hospital where the procedure or admission will occur. The primary care practitioner must issue a Gateway referral to the specific Gateway participating hospital’s outpatient laboratory.

STAT laboratory services must only be utilized in urgent cases. If a lab other than the member’s designated lab is to be used, a referral form is required. Every effort should be made to direct the member to his/her designated lab.

As part of the Growing Up with Gateway^SM Program, primary care practitioners are required to use a blood lead test to screen children at ages one and two, and children 36-72 months of age who have not previously been screened. All children who receive Medical Assistance are considered at risk; therefore, all Gateway children between 36-72 months should be screened if not previously screened. In addition to Gateway’s contracted designated laboratories, Gateway has also contracted with Kirby Memorial Health Center to process blood lead samples for Gateway members. Kirby Health Center will process blood lead samples ONLY, and all other laboratory work must be sent to the member’s designated laboratory.

The primary care practitioner can use either their designated laboratory or Kirby Health Center Laboratory to process blood lead samples. If you choose to send blood lead samples to Kirby Health Center, you must use the sample Lead Analysis ID Form found in the Forms and Reference Materials Section of this Manual. The Form is only for Gateway members, and when completing the form please verify the member’s eligibility. All demographic information, including the practitioner name, member name, member address, member date of birth, Gateway Member Identification Number, and the date of service must be completed for the sample to be processed.

A supply kit of Gateway Lead ID Forms, postage-paid mailers, instructions, capillectors or filter papers for sample collection, and supply reorder forms may be requested through Kirby Health Center Laboratory by calling 1-888-841-6699. When ordering a supply kit, please identify yourself as a participating Gateway practitioner.

Should circumstances arise where it is impossible to follow the laboratory procedures outlined above, please contact Gateway’s Utilization Management Department at 1-800-392-1146 for assistance.