Ala. Admin. Code r. 560-X-9-.06 - Claims Filing Guidelines

(1) For time limits on claims submission refer to the Medicaid Provider Manual, Independent Laboratory chapter.

(2) Claims for lab services must contain a valid diagnosis code.

(3) Claims submitted must contain the provider number of the lab that actually performed the services. Claims must not be submitted using any other provider's number, such as the provider number of the referring physician or hospital.

(4) All organ and disease oriented panels must include the tests listed with no substitutions. If only part of the tests included in a defined panel are performed, the panel code should not be reported. If additional tests to those indicated in a panel are performed, those tests should be reported separately in addition to the panel code. If two panels overlap, the physician or laboratory will be required to unbundle one of the panels and bill only for the tests that are not duplicative.

Author: Lynn Sharp, Associate Director, Policy Development Unit

Notes

Ala. Admin. Code r. 560-X-9-.06

Ed. Note: Previous rule "Contractual Requirements" effective October 1, 1982. Emergency repeal effective October 15, 1990. Permanent repeal effective January 15, 1991. Amended: Filed September 8, 1998; effective October 13, 1998. Amended: Filed November 6, 2000; effective December 11, 2000.

Statutory Authority: State Plan, Title XIX Social Security Act; 442 C.F.R. §§405.401 et seq.