Laboratory Provider All Child Health and Disability Prevention (CHDP) Laboratory Providers

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This section includes information about clinical laboratory provider responsibilities and billing for laboratory services.

Notice: CHDP services must be billed on a CMS-1500 or UB-04 claim form as follows:  Laboratory-only services billed by clinical laboratory providers: Claims with dates of service on or after February 1, 2017  Well-child health assessments/vaccines and laboratory in combination with other services: Claims with dates of service on or after July 1, 2017 Refer to the CHDP Transition to National Standards section in this manual for information. Policies and billing instructions in this manual section are primarily for claims billed with two-character CHDP codes on the Confidential Screening/Billing Report (PM 160) for dates of service on or before January 31, 2017 (lab only) or on or before June 30, 2017 (well-child, vaccine and lab [in combination]). Instructions for billing services on the PM 160 will be retained in this provider manual until the Department of Health Care Services (DHCS) directs its removal or update.

Laboratory Provider All Child Health and Disability Prevention (CHDP) laboratory providers Responsibilities are required to maintain enrollment in the CHDP program as outlined in the Provider Enrollment section of this manual.

In addition, laboratory providers are responsible for the following:  Maintaining active status as a Medi-Cal provider  Providing and documenting on the Confidential Screening/ Billing Report (PM 160) claim form those CHDP laboratory tests that have been completed at an approved laboratory site  Referring families and/or patients to their health care provider for obtaining results of the tests  Maintaining licensure or registration as a clinical laboratory in accordance with Department of Health Care Services (DHCS) standards  Maintaining proficiency in blood lead analysis in accordance with DHCS standards (for blood lead labs only)

Gateway Transactions/ Laboratory providers do not perform Gateway transactions. These Medi-Cal Eligibility transactions pre-enroll eligible children and youth in fee-for-service, full-scope Medi-Cal for up to two months. Laboratory providers are responsible for verifying that the patient is eligible for Medi-Cal for the month in which services are rendered. Instructions for verifying recipient eligibility are located in the Medi-Cal provider manuals.

Additional information about Gateway transactions is available in the Gateway Transactions Overview section of this manual.

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Health Assessment The CHDP program reimburses CHDP laboratory providers only for Request for Lab Test laboratory tests identified as necessary by a CHDP health assessment or comprehensive care provider. That is, in all instances claims for laboratory tests are to be submitted only for children whose health assessment prompted the request for laboratory testing.

Laboratory Guidelines Important information about laboratory tests, guidelines and and Reimbursement reimbursement is located under “Laboratory Tests” and “Blood Lead Tests” in the Child Health and Disability Prevention (CHDP) Program: Billing and Reimbursement section of this manual.

Bill Tests as Laboratories bill all lab tests as partial screens. Partial Screens

Reimbursable The following are CHDP reimbursable laboratory tests. Laboratory Tests Code Description

08 Hemoglobin or hematocrit 09 Urine dipstick 10 Urinalysis, routine, complete 13 Hemoglobin electrophoresis 15 Blood lead 16 VDRL, RPR or ART 17 Gonorrhea (GC) test 18 Pap smear 20 Chlamydia test 22 Ova and/or parasites 25 Blood glucose 26 Total cholesterol

Additional information and rates for these codes are located in the Rates: Maximum Reimbursement for CHDP section of this manual.

PM 160 The CHDP Confidential Screening/Billing Report (PM 160) is used by laboratory providers for the following.

 Fee-for-service reimbursement for laboratory tests  Reporting results of laboratory tests

Claim completion instructions are included in the Confidential Screening/Billing Report (PM 160) Claims Form: Completion Instruction for Labs section of this manual.

Laboratories CHDP 20 April 2006