Respond to the Insurance Coverage Rules
1 If the Additional Information section includes an Insurance Coverage Rules area, respond as appropriate:
• Specify a different test. Click Yes to go to the Tests section, remove the test that is not covered, and specify a different one that is medically appropriate for the patient’s condition for this date of service (as described in Specify a Test).
• Review the covered tests. Click the View Covered Services Policies link. The right side of the page displays a list of covered tests.
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Tip: To sort the listed items, click the appropriate column heading. You can click the column heading again to reverse the sort order. |
If you click one of the listed tests, it appears in the Tests section. However, the original test is not removed unless you manually remove it from the order.
If the order already contains the maximum allowed number of order codes, the chosen code is not added, and a message appears. You must remove one of the existing codes before you can add another.
• Acknowledge that the test is not covered. If there are no other medically appropriate tests for the patient’s condition, click No. You can proceed with the order, but the guarantor might be responsible for paying for the test.
• The test is covered only for specific diagnoses:
• Specify a diagnosis. Click Yes to go to the Diagnoses section and specify a medically appropriate diagnosis for this date of service (as described in Specify a Diagnosis).
• Select a diagnosis. Click the test in the Tests Not Satisfying Limited Coverage Policies area.
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Note: Supported diagnosis codes are only shown for commercial insurance carriers that have a limited coverage policy on file; otherwise, the test does not appear as a clickable link. |
The coverage policy associated with that test opens in a separate window. Review the coverage policy, and then click I Acknowledge to acknowledge that you have reviewed and understand the policy.
The right side of the page displays a list of the diagnoses for which the ordered test would be considered medically necessary (supported) by the insurer, or those that are not considered medically necessary (unsupported), if applicable. If the list includes a medically appropriate diagnosis for this date of service, click that diagnosis to add it to the Diagnoses section. (If the order already contains the allowed number of diagnoses, the chosen code is not added, and a message appears. You must remove one of the existing diagnoses before you can add another one.)
• Acknowledge that the diagnosis does not meet the requirements. If there are no other medically appropriate diagnoses for this date of service, click No. You can proceed with the order, but the guarantor might be responsible for paying for the test.
• The test requires a secondary diagnosis:
• Specify a secondary diagnosis. Click Yes to go to the Diagnoses section and specify a medically appropriate diagnosis for this date of service (as described in Specify a Diagnosis).
• Select a secondary diagnosis. Click the test in the Tests Not Satisfying Secondary Diagnosis Policies area.
The coverage policy associated with that test opens in a separate window. Review the coverage policy, and then click I Acknowledge to acknowledge that you have reviewed and understand the policy.
The right side of the page displays a list of the secondary diagnoses that are either supported or unsupported by the limited coverage policy. If the list includes a medically appropriate diagnosis for this date of service, click that diagnosis to add it to the Diagnoses section. (If the order already contains the allowed number of diagnoses, the chosen code is not added, and a message appears. You must remove one of the existing diagnoses before you can add another one.)
• Acknowledge that the diagnosis does not meet the requirements. If there are no other medically appropriate diagnoses for this date of service, click No. You can proceed with the order, but the guarantor might be responsible for paying for the test.
2 Go to one of the following sections, depending on what is appropriate for this order:
