Effective September 19th, when medical records are not submitted to support the code billed (for the laboratory and pathology codes linked below), the service will reject. The claim must then be resubmitted with the appropriate documentation.
Documentation submitted from the medical record to support the initial claim submission for the pathology and lab codes linked below may include one or more of the following:
Orders and test results for the test performed
History and physical examination
Progress or office notes for the test performed
Any additional documentation in the medical record that supports the need for the service
Avoid negative impacts to your claims by providing medical records with your initial claim submission for the pathology and lab codes linked above. Please consult this list frequently as it may be updated quarterly.
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