Certain Clinical Lab Services Rejected Incorrectly

States Applicable to Alert
Northern> & Southern California, Nevada, Hawaii, Guam, American Samoa and Northern Mariana Islands.

Background Information
Changes to the anti-markup payment limitation editing (a.k.a., purchased service) were implemented on April 5, 2010. For certain electronic claims that contained reference lab services and a purchased service amount, the system was misreading pricing information in Loop 2400, segment PS102 as blank. This caused services to reject when an actual amount was present.

Applies To Procedure Codes
Laboratory services paid from the Clinical Lab Fee Schedule submitted with CPT modifier 90.

Remark/Reason Codes
MA111 – Missing, incomplete and invalid purchase price of the tests and/or the performing laboratory's name and address.

MAC Action
A mass adjustment will be performed for any electronic claim rejected with remittance advice remark code MA111 processed between April 5 and April 29.

Provider Action

Date Reported
April 27, 2010

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