DAPS, P.A. uses a single test requisition form for all laboratory services.  Each requisition is preprinted with the client’s name, address, telephone number, and account number to assure that the resulting medical report is properly directed.  The following information is required on the requisition in order to process the specimen and bill for the service rendered:

Patient Information:

Record patient’s name, sex, date-of-birth, and other relevant demographic information.

Specimen Information:

  • Specimen collection date and time along with specimen type.
  • Provide a written diagnosis or diagnosis code per the ICD-9 nomenclature.
  • Indicate if you want additional copies sent and to whom.

Billing Information:

  • Indicate if this request should be billed to the physician/clinic, to an HMO, PPO, or PCN, to the patient, to an insurance company, to Medicare, or to Medicaid by placing a check mark in the appropriate box.
  • If patient billing, record patient address in the patient information section of the requisition along with the patient’s telephone number. Record insured party’s name and telephone number in the billing information section.
  • If Medicare or Medicaid billing, record the patient’s Medicare or Medicaid number in the appropriate spaces.
  • Medicare has permitted laboratories to obtain ABNs (Advance Beneficiary Notices) for screening Pap smears.  Medicare has recognized that because screening Pap smears are usually covered only once every three years, patients may be uncertain whether or not they have had a Pap smear performed (and covered by Medicare) within that time period.  As a result, we ask that you have all beneficiaries for whom you are ordering screening Pap smears sign the beneficiary notice on the requisition. Please explain to your patients that if they sign the notice and Medicare does not pay for the Pap smear, then we will consider the patient financially liable.  If a beneficiary does not wish to sign this, she may refuse to do so.  However, in that case, DAPS may determine that it cannot provide the testing service.
  • If Medicaid billing, record the state in which the Medicaid recipient lives.
  • If HMO or Insurance billing, record the following information for the primary and, if applicable, secondary insurance carriers:
    • patient’s complete home address and telephone number;
    • insurance company name; insurance company address,
    • patient identification number or social security number, group number, insured party’s name and telephone number, and insured party’s employer and employer’s telephone number.

Testing Requested:

  • Record all requested tests and/or procedures.  Only tests/procedures which are medically necessary should be requested.


Doctors’ Anatomic Pathology Services, P.A. offers three alternatives for billing laboratory services.  At the client’s discretion, DAPS, P.A. will bill the client directly for services rendered to a patient or bill the patient directly. As an adjunct to direct billing, DAPS, P.A. will also bill any third-party agency, provided that all required billing information is recorded on the test requisition. For the various billing options please fill out the request forms completely for each billing type.

Monthly Account Billing:

If the client elects to be billed directly for laboratory services performed, an itemized statement will be received each month detailing date-of-service, the patient’s name, procedure number, procedure description, and charges.

All billing inquires may be submitted to DAPS, P.A. in writing or by calling (870) 932-5150 or (800) 764-0447.  Please include client account numbers on all written correspondence.

Direct Patient Billing Service:

When requested by the client, DAPS, P.A. will bill patients directly if all necessary billing information is recorded on the test requisition. Each test requisition submitted will result in a separate bill from DAPS, P.A.  Since CPT coding methodology has been adopted by most third-party payers including Medicare and Medicaid, our patients bills are charged using CPT coding procedures as prescribed by the American Medical Association.

Payment of a patient bill is due upon receipt and, if not paid, will be followed by subsequent reminders and normal collection activity.

Third-Party Billing Service:

For patients who are subscribers to or recipients of benefits from a third-party agency, DAPS, P.A. will bill the agency directly for services performed. It is very important to include the employer name when third party insurance is indicated. We are unable to file and/or follow up on most claims without this information.  The patient may be billed concurrently with the insurance company and is ultimately responsible for payment of the total charges including denied claims, co-payments, deductibles, and amounts above the insurance company’s usual, customary and reasonable (UCR) fee schedule. The only exceptions to this dual invoicing are Medicare, Medicaid, and managed care organizations which DAPS, P.A. has signed contracts agreeing to accept payment and bill only for deductible and/or co-payment.

To insure proper submission of your patients’ insurance claims, please make certain that all required billing information is recorded and is correct. It is particularly important that Medicare and Medicaid numbers are recorded in the spaces provided on the requisition form and that the patient’s name is recorded as it appears on their Medicare or Medicaid cards. In addition, most third-party insurance companies, including Medicaid, are now requiring a written diagnosis or diagnosis code per the ICD-9 terminology before payment can be made.  Only tests which are medically necessary should be ordered.

Indigent and Needy Patients:

Tests are performed at no charge for indigent patients when the physician or hospital does not charge the indigent patient for services.  In this case indicate “Indigent Patient - No Charge” on the requisition form.

In the case of patients who are needy rather than indigent, DAPS, P.A. will reduce its fee by the same percentage reduction given by the physician or hospital.  In this situation, please indicate “Needy Patient” (and your percentage reduction) on the requisition form.

Please Note: The ordering physician must sign the requisition beside the request for “no charge” or “discount” before DAPS, P.A. will honor these types of special requests.


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