Palmetto GBA has changed the effective date for claim submissions under its new Molecular Diagnostic Services Program (MolDx) from March 1 to May 1 and will give laboratories a choice between applying for the McKesson Z-Code or an alternate test identifier from Palmetto.
The changes were made in response to concerns raised by the laboratory industry over the new program for determining coverage and payment for molecular tests in the J1 region. Under Palmetto’s MolDx program, announced in November 2011, laboratory service providers will register their molecular diagnostic tests with Palmetto and submit test information and supporting evidence for a coverage and reimbursement determination. In comments to Palmetto, many in the lab industry expressed concerns about Palmetto’s requirement that they obtain a unique Z-Code from McKesson, a consulting company and third-party vendor. Lab groups also opposed the March 1 implementation deadline, saying it did not give them enough time to prepare for the new program.
Palmetto released an update to the MolDx program on Feb. 3 in which it attempts to address these concerns. The carrier says it has revised the license agreement used for the Z-Code application to reduce the administrative burden and also has provided an alternate code application process called the Palmetto Test Indicator (PTI). For labs unable to implement systems for meeting the MolDx additional information timelines to include this information on their claims, Palmetto has updated its electronic claims fax cover sheet to allow submission of the test identifier via fax "attachment" to an electronic claim. If no test identifier (Z-Code or PTI) has been issued, Palmetto has developed a MolDx test information form. This form may be faxed with each test claim submission to identify the MolDx service provided. This form may be used until Sept. 1, 2012.
The effective date of the MolDx program has been delayed for two months, from March 1 to May 1. Claims received with paid dates of services on and after May 1, 2012, without one of the listed identifiers or a fax with the required information will be rejected for insufficient document.
Source: Medicare Part A and Part B MAC for Jurisdiction 11; comprised of North Carolina, South Carolina, Virginia and West Virginia. Medicare Part A and Part B MAC for Jurisdiction 1; comprised of California, Hawaii and Nevada.