PROVIDE US WITH A CLEAN CLAIM COPY

- Request forms with Original Doctor Stamp & signature.

- Claim forms with Original Doctor Stamp & signature

- Claim forms with supporting ICD-10CM and approved CPT codes.

- Patient signature wherever required in the claim form.

- Pre-approvals with approved CPT List.

- Insurance card copy (Clear Front & Back side).

- Patient Eligibility copy (Were ever required)

- Patient Consent form (Insurance / Laboratory).

- For other insurances (Pre-approval Copies / Mails
COMPONENTS / ANALYTES CPT
Alanine Amino Transferase 84460
Albumin 82040
Amylase 82150
Alkaline phosphatase 84075
ASO Quantitative 86060
Asparatate Amino Trasferase-(AST) 84450
Bilirubin,Direct 82248
Bilirubin,Total 82247
Calcium,Total 82310
Chloride 82435
Cholesterol Total 82465
Cholesterol,LDL 83721
Cholesterol,HDL 83718
Creatinine Kinase-CK 82554
Creatinine 82565
CRP 86140
GGT 82977
Iron Binding, Unsaturated 83550
Iron 83540
Lipase 83690
Magnesium 83735
Phosphorus 84100
Potassium 84132
* A Clean claim is defined as a claim which has no defect, impropriety or special circumstance,
including incomplete documentation
 Protein-Total 84155
RF Quantitative 86431
Sodium 84295
Triglyceride 84478
Urea 84520
Uric Acid 84550
Glucose 82947
Hemoglobin A1C 83036
Microalbumin 82043
Cortisol 82533
B-HCG 84702
Creatinine Kinase-CK-MB 82553
Ferritin 82728
Folate 82746
FSH 83001
Insulin 83525
LH 83002
Prolactin 84146
Progesterone 84144
Prostatic Specific Antigen (PSA TOTAL) 84153
COMPONENTS / ANALYTES CPT
Thyroxine (Free T4) 84439
Testosterone Total 84403
T3 Free 84481
Troponin T, Quantitative 84484
Thyroid Stimulating Hormone (TSH) 84443
Vitamin D (TOTAL) 82306
Vitamin B12 82607
Prothrombin Time 85610
APTT 85730
Periphereal Smear 85060
Blood Flim For Hemoparasites(Malaria/Filaria) 87207
Red Blood Cell Count 85041
Platelet Count 85049
HCT 85014
Hemoglobin 85018
WBC 85048
Differential count 85009
Complete Blood Count (CBC) 85025
ESR-Manual 85651
Urine Analysis 81001
Fecal Occult Blood 82270
Ova and Parasite identification Cyst and Trophozoites 87177
Blood Culture 87040
Culture ear/eye/sputum/throat swab 87071

* A Clean claim is defined as a claim which has no defect, impropriety or special circumstance,
including incomplete documentation
 Urine culture 87086
Stool culture 87045
Group A Streptococcus Antigen Detection 87880
Gram Stain 87205
H.pylori Antigen Detection 87338
Influenza A and B Antigen Detection 87804
RSV Antigen Detection 87280
Rotavirus Antigen Detection 87425
Acid Fast Stain 87206
Anti-HBS 86706
HIV Combi 1 & 2 Antibodies and Antigen 86703
HBSAG 87341
Anti-HCV 86803
Widal 86768
H.pylori antibodies, Total 86677
Rapid Phospholin Reagen (RPR) 86592
UBT 78268

LIPID PROFILE 80061

LIVER FUNCTION TEST 80076

COMMON REJECTIONS
MNEC-004 Service is not clinically indicated based on good clinical practice, without additional
supporting diagnoses/activities

MNEC-003 Service is not clinically indicated based on good clinical practice

MNEC05 Service/supply may be appropriate, but too frequent

ELIG-001 Patient is not a covered member

ELIG-007 Services performed by a non-network provider

PRCE-002 Payment is included in the allowance for another service

CLAI-012 Submission not compliant with contractual agreement between provider & payer.

NCOV-003 Service(s) is (are) not covered

CODE-013 Activity/diagnosis inconsistent with clinician specialty

CODE-014 Activity/diagnosis is inconsistent with the patient's age/gender

PRCE-007 Service has no contract price

NCOV-001 Diagnosis(s) is (are) not covered

* A Clean claim is defined as a claim which has no defect, impropriety or special circumstance,
including incomplete documentation