CMS

Medicare Learning Matters:  MM4293 (PDF).
Publication Date: March 31, 2006
Effective Date: October 01, 2006

Claim form CMS-1500 (12-90) is revised to accommodate the reporting of the National Provider Identifier (NPI) and will be named CMS-1500 (08-05). The CMS-1500 (08-05) version is effective October 01, 2006, but is not mandated for use until February 01, 2007.

The following timeline outlines the schedule for the revised claim:

• October 01, 2006 - January 31, 2007: Providers can use either the current CMS-1500 (12/90) version or the revised CMS-1500 (08/05) version of the claim form.
• February 01, 2007: The current CMS-1500 (12/90) version of the claim form is discontinued; only the revised CMS-1500 (08/05) form is to be used, including rebilling of claims previously billed using the old format.

Related information:   Transmittal 899.

  California: Medi-Cal

Medi-Cal Update:  GM Bulletin 381.
Publication Date: April 2006

Retroactive to dates of service on or after January 05, 2004, laboratory services are subject to frequency limits. These limits are set per recipient, per service, per month via the Laboratory Services Reservation System (LSRS). The claim must be billed with the provider number used to make the reservation.

Frequency limits may be overridden when the provider submits medical justification to support the frequency of the laboratory service for a recipient. Laboratory claims denied due to frequency limitations may be appealed with submission of medical justification. Failure to make a laboratory service reservation prior to performing the laboratory service may result in denial of the claim.

The following entities are excluded from frequency limitations when the full laboratory service is rendered onsite: End Stage Renal Disease (dialysis) clinics, county public health clinics, Skilled Nursing Facilities (SNFs), inpatient hospitals and emergency rooms. The following programs are excluded from frequency limitations: California Children's Services, Genetically Handicapped Persons Program and Child Health and Disability Prevention program.