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Junction supports lab test orders billed to commercial insurance. Availability depends on the lab account, patient state, and tests selected for the order.

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Commercial insurance workflow

Complete these steps in order:
  1. Create a user, or use an existing user, and ensure the user has patient demographics. Creating a user establishes the Junction user ID but does not create the demographics required for insurance. Use Update User Demographics to add or update them.
  2. Check insurance availability for the intended lab account and patient state.
  3. Create insurance for the user. Junction associates the insurance with that user’s demographics.
  4. Create the order for the same user with billing_type set to commercial_insurance and valid diagnosis codes in icd_codes.
Create the user’s insurance before creating the order. is_primary defaults to true, and Junction uses the user’s most recently created primary insurance record for commercial insurance ordering. When the insurance details change, create a new primary insurance record before placing another order.

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Create user insurance

Use POST /v2/user/{user_id}/insurance to create an insurance record. The endpoint creates a new record; it does not update an existing one. The user must already have demographics, including an address, because Junction links the insurance to that patient record. Insurance details can change over time. Keep the user’s insurance current to reduce the risk of a denied claim.
group_id, second_line, and guarantor are optional. A guarantor is required when relationship is not Self.

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Insured, guarantor, and relationship

The insured object identifies the person covered by the insurance plan and is always required. The relationship value describes the patient’s relationship to the policyholder and accepts Self, Spouse, or Other. When relationship is not Self, provide the financially responsible party in guarantor. If you provide a guarantor when relationship is Self, Junction stores it, but some lab partners may not accept it.

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Payor code

Partner labs use different identifiers for insurance companies. Junction standardizes these identifiers so you can use one Junction payor_code across supported labs. Use Search Payor Code to find the insurance company and use the returned payor_code when creating insurance. You can search by insurance company name or by a supported external provider’s payor code, such as Change Healthcare or Availity.
Contact Junction Customer Support for assistance if the payor information you need is missing.

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Check insurance availability

Not every lab account, state, or test supports commercial insurance. Review the billing types configured for the lab account, then call Area Info for the patient’s zip code and confirm that the intended lab includes commercial_insurance in supported_bill_types. If you intend to use a specific lab account, pass its lab_account_id to Area Info and provide the same lab_account_id when creating the order. This ensures the availability check uses that account’s billing configuration.

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Create the order

Create the order for the same user_id used to create the insurance. Include all fields required for a standard order, then set:

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Billing type

Orders use client_bill by default. Set billing_type to commercial_insurance to use the user’s latest primary insurance record.

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Diagnosis codes

Commercial insurance orders require at least one valid diagnosis code. Use Search ICD Code to find supported codes.

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Common errors

Junction rejects a commercial insurance order when:
  • The selected lab account does not support commercial_insurance.
  • The patient’s state does not support commercial insurance for the selected lab account.
  • The selected test or one of its markers is not available for commercial insurance in the patient’s state.
  • icd_codes is missing or contains an invalid diagnosis code.
  • The user does not have patient demographics or a primary insurance record.

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Medicare and Medicaid location inference

This feature is in closed beta.Interested in this feature? Get in touch with your Customer Success Manager.
The closed beta can infer the appropriate Medicare or Medicaid plan from the patient’s address when you create user insurance on the beta channel:
  • Use MEDFED for Medicare.
  • Use MAIDFED for Medicaid.
For example, submitting MEDFED for a patient who lives in Arizona creates the insurance record with the applicable Arizona Medicare plan payor code. This beta applies only to Medicare and Medicaid location inference. It does not apply to commercial insurance ordering as a whole.