Respond to the ICR Prompts
1 Click the ICR tab.
2 Take the appropriate action:
• The test is not covered. When a particular test is not a covered service for the insurance plan selected, the Tests Are Not Covered Services for the Insurance Selected message appears.
Do one of the following:
• Order a different test. If there are other medically appropriate tests for the patient’s condition, click Yes, Modify Order Codes for This Date of Service.
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), you can make the appropriate changes to the order (as described in Specify a Test).
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 Order Code box.
• Click No to discard your changes and go to the Order Code box.
• Click Cancel to keep the Verify Order Code Info dialog box open.
• Acknowledge that the test is not covered. If there are no other medically appropriate tests for the patient’s condition, click No, I acknowledge this service is not a benefit of the program.
You can complete the other tabs (if any) as described in the following sections:
When you have finished, click Save. You can proceed with the order, but the guarantor might be responsible for paying for the test.
• Review the covered tests: To view a list of tests that are covered by the carrier, click View Covered Services Policies.
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Tip: To return to the previous ICR prompts at any time, click Back. |
If more than 10 covered tests are available, you can click the navigation icons at the top of the list to move from one page to another.
If you select one of the listed check boxes and then click Save, the selected test appears in the Profiles/Tests area. However, the original test is not removed unless you remove it from the order manually (as described in Specify a Test).
If the order already contains the maximum allowed number of order codes, the selected code is not added, and a message appears. One of the existing codes must be removed before another can be added.
• The test is covered only for specific diagnoses. When a particular test is covered only for specific diagnoses, the Limited Coverage Policies for Tests Not Currently Satisfied message appears.
Do one of the following:
• Provide a different diagnosis. If there are other medically appropriate diagnoses in the patient’s chart for the patient’s condition, click Yes, Add Additional Diagnosis Codes for This Date of Service.
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), you can add any appropriate diagnoses (as described in Specify a Diagnosis).
If you made any other changes on the Verify Order Code Info dialog box (such as providing AOE, template, or Pap data), you are prompted about saving your changes. Do one of the following:
• Click Yes to save your changes and go to the Diagnosis 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.
When an appropriate diagnosis is added to the order, the message prompting you to respond to the ICR and the empty dark blue box next to the test name no longer appear.
• Acknowledge that the diagnosis does not meet the requirements. If there are no other medically appropriate diagnoses for the patient’s condition, click No, I acknowledge this diagnosis does not meet the requirement.
You can complete the other tabs (if any) as described in the following sections:
When you have finished, click Save. You can proceed with the order, but the guarantor might be responsible for paying for the test.
• Review the supported or unsupported diagnoses. To view a list of diagnoses for which the ordered test would be considered medically necessary (supported) by the insurer, or those that are not considered medically necessary (unsupported), click View Insurance Limited Coverage Policies, and then click the desired test.
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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 View Insurance Limited Coverage Policies button does not appear. |
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 tab displays a list of the supported or unsupported diagnoses.
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Tip: To return to the previous ICR prompts at any time, click Back. |
If more than 10 diagnoses are available, you can click the navigation icons at the top of the list to move from one page to another.
If you select one of the listed check boxes and then click Save, the selected diagnosis appears in the ICD Diagnosis Codes area, and the message prompting you to respond to the ICR and the empty dark blue box next to the test name no longer appear.
• The test is deemed non-medically necessary. When a particular test is deemed experimental, investigative, and unsupported (EIU), the Non-Medically Necessary Tests Ordered - No Covered Dx Codes message appears.
Do one of the following:
• Acknowledge that the test is not covered. If the patient agrees to take responsibility for payment for the EIU test, click I acknowledge that this test will not be covered by the Insurance Carrier.
You can complete the other tabs (if any) as described in the following sections:
When you have finished, click Save. You can proceed with the order, but the guarantor might be responsible for paying for the test.
• Review the supported diagnoses. To view a list of diagnoses for which the ordered test would be considered medically necessary (supported) by the insurer, click View EIU Policies, and then click the desired test.
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 tab displays a list of the supported diagnoses.
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Tip: To return to the previous ICR prompts at any time, click Back. |
If more than 10 diagnoses are available, you can click the navigation icons at the top of the list to move from one page to another.
If you select one of the listed check boxes and then click Save, the selected diagnosis appears in the ICD Diagnosis Codes area, and the message prompting you to respond to the ICR and the empty dark blue box next to the test name no longer appear.
• The test requires a secondary diagnosis. For some limited coverage tests, a secondary diagnosis is required. When this occurs, the Secondary Diagnosis Policies for Tests Not Currently Satisfied message appears.
Do one of the following:
• Provide a secondary diagnosis. If there are additional medically appropriate diagnoses in the patient’s chart for the date of service, click Yes, Add Additional Diagnosis Codes for This Date of Service.
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), you can make the appropriate changes to the order (as described in Specify a Diagnosis).
If you made any other changes on the Verify Order Code Info dialog box (such as providing AOE, template, or Pap data), you are prompted about saving your changes. Do one of the following:
• Click Yes to save your changes and go to the Diagnosis 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.
When an appropriate secondary diagnosis is added to the order, the message prompting you to respond to the ICR and the empty dark blue box next to the test name no longer appear.
• Acknowledge that the diagnosis does not meet the requirements. If there are no other medically appropriate diagnoses for the patient’s condition, click No, I acknowledge this diagnosis does not meet the requirement.
You can complete the other tabs (if any) as described in the following sections:
When you have finished, click Save. You can proceed with the order, but the guarantor might be responsible for paying for the test.
• Review the supported and unsupported secondary diagnoses. To view a list of supported secondary diagnoses, or the unsupported secondary diagnoses, click View Insurance Secondary Diagnosis Policies, and then click the desired test.
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 tab displays a list of the supported or unsupported secondary diagnoses.
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Tip: To return to the previous ICR prompts at any time, click Back. |
If more than 10 diagnoses are available, you can click the navigation icons at the top of the list to move from one page to another.
If you select one of the listed check boxes and then click Save, the selected diagnosis appears in the ICD Diagnosis Codes area, and the message prompting you to respond to the ICR and the empty dark blue box next to the test name no longer appear.
3 Provide specimen collection information (as described in Provide Specimen Collection Information).
