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Notifying Payors When Using Unclassified Codes

May 1, 2011

Gary K. asked about the responsibility labs have in notifying payors when using unclassified codes (see his whole question at the end of this post). My answer is, the test name should be on the claim. Almost all claims submitted using an NOC end up being individually negotiated. How and when to begin interaction with payors is a strategic decision and based on lab specific circumstances. There are definitive regulations about offering tests on a field experience trial basis. Please contact us if you would like information re our consulting services and how we can help you formulate effective and compliant strategies.

Posted by Gary Kenney on August 16, 2010:

When billing lab services using unclassified codes, what responsibility does the performing lab have in notifying Payors before they launch these tests? If the Provider does not have supporting body of evidence information, what compliance standards govern proving these services for free?

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