Respond to the ABN Prompts
1 Click the ABN tab.
The top of the tab displays a list of the tests that triggered the ABN, including a symbol that indicates why each test might not be covered.
2 Do one or more of the following:
• Add any additional diagnoses:
a Click Yes, Add Additional Diagnosis Codes for This Date of Service.
b If there are no other tabs, or if you completed all of the other tabs (as indicated by a filled box next to each tab name), go to the next step.
If you made any other changes on the Verify Order Code Info dialog box (such as providing AOE, template, or Pap data), a message appears, asking if you want to save your changes. Do one of the following:
• Click Yes to save your changes and go to the Diagnosis box. (Unless you have already scheduled the order for the future as described in Provide Specimen Collection Information, all of the required fields must be completed before you can close the Verify Order Code Info dialog box.)
• Click No to discard your changes and go to the Diagnosis box.
• Click Cancel to keep the Verify Order Code Info dialog box open.
c Specify the diagnosis (as described in Specify a Diagnosis).
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Note: If a particular test can be performed only a predefined number of times, the message and empty purple box continue to appear. You must click the box, click No, File Order. A Signed ABN is Required for This Requisition, and submit the signed ABN, even if you added a diagnosis that the payer considers to be medically necessary. |
• Include a signed ABN with the requisition:
a Click No, File Order. A Signed ABN is Required for This Requisition.
b (Optional) If the patient’s preferred language is Spanish, select the Spanish ABN check box. The ABN will appear in Spanish when the order is filed. (If the patient’s Preferred Language was previously set to Spanish, the check box is preselected by default.)
c Complete the other tabs (if any) as described in the following sections:
d Click Save.
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Note: If the test is being performed by a third-party lab (such as ProHealth Labs), make sure that the order includes the appropriate order code to ensure that the contact information for the third-party lab appears on the ABN. |
A signed ABN must accompany the requisition. The ABN can either be printed and submitted with the requisition, or completed and submitted electronically (if electronic ABN signing is enabled).
• Review the acceptable diagnoses for each test:
a Click Diagnosis Code Reference Guide.
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Tip: To return to the previous ABN prompts at any time, click Back. |
b In the Select Test to Display Rules area, click the desired test.
The coverage policy associated with that test opens in a separate window.
c Review the coverage policy, and then click I Acknowledge to acknowledge that you have reviewed and understand the policy.
The tab displays a list of the diagnoses for which the test is considered medically necessary (supported), or those that are not considered medically necessary (unsupported), if applicable.
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Tip: If more than 10 diagnoses are available, click the navigation icons at the top of the list to move from one set of codes to another. |
d To add one of the listed diagnoses to the order, select the check box next to that code. (You can select more than one check box—up to the allowed number of diagnoses, including any that you previously specified—and you can clear any check box at any time.)
e Complete the other tabs (if any) as described in the following sections:
f Click Save.
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Notes: • If a particular test can be performed only a predefined number of times, the message and empty purple box continue to appear. You must click the box, click No, File Order. A Signed ABN is Required for This Requisition, and submit the signed ABN, even if you added a diagnosis that the payer considers to be medically necessary. • If the test is being performed by a third-party lab (such as ProHealth Labs), make sure that the order includes the appropriate order code to ensure that the contact information for the third-party lab appears on the ABN. |
• Review the general rules under which a test might not be covered:
a Click ABN Rules Documentation in the tab heading.
The tab displays the rules, including the symbol associated with each rule. (One of these symbols appears after each test name at the top of the ABN tab, and when you position the pointer over the purple box in the Profiles/Tests area.)
b When you have finished reviewing this information, click Back.
3 Provide specimen collection information (as described in Provide Specimen Collection Information).
