News-At-A-Glance: Minnesota to Require Reference Lab Bill

Effective Oct. 1, labs in Minnesota who wish to bill for patients enrolled in Minnesota Health Care Programs (MHCP), that refer tests to another lab are not to bill for the tests themselves and instead will be required to provide the necessary information to allow the performing lab to file the claim. This change likely will cause some problems for out-of-state labs because, to be eligible for MHCP payment, they will need to enroll as an MHCP provider. Until the effective date of the new requirement, labs may file the claims themselves or allow the reference lab to bill. If the lab chooses to bill for the reference lab tests, claims should include a 90 modifier, the national provider identifier of the performing lab, and place of service code 81 for independent labs. Claims that include a 90 modifier after Oct. 1 will be denied. Laboratories affected by this change may want to file enrollment applications as soon as possible to avoid a potential backlog if many labs try to enroll at the last minute. Information on enrollment, fee schedules and other important topics, can be found on the MHCP home page at http://mn.gov/dhs/. Select “A-Z Topics” in the upper right of the page then select “independent lab providers” from the list.