Laboratory Orders Must be Submitted Within 12 Months of Order - JF Part B

Noridian has received notice of errors from the Comprehensive Error Rate Testing Contractor (CERT) for laboratory claims that have "Standing Orders" that are over 12 months old. In some cases, specifically for End Stage Renal Disease beneficiaries, standing orders submitted for review were over 12 months old.

When the laboratory service(s) is initially ordered, medical necessity is established; therefore, at the time of the initial order, the beneficiary's medical records must include documentation indicating the service is reasonable and necessary as well.

In addition to information that justifies the initial provision of the service (s), clinical information must be in the beneficiary's medical record to support that the laboratory service continues to remain reasonable and necessary. For the claim (date of service) under review, information used to justify continued medical need must be timely.

Noridian has determined that timely documentation for laboratory service standing orders is defined as a medical record in the preceding 12 months. Providers may wish to set a reminder to renew such orders on or about 12 months from the previous order.