Provider Attestation
I, {providerName}, certify and authorize the following:
- Designated staff members* may transmit laboratory test orders to Knoxville Dermatopathology, LLC, on my behalf and under my direction, in the form of paper requisitions or electronic orders. This authorization applies solely to the transmission of orders and does not replace requirements for a valid physician order, documentation of medical necessity, or provider authentication.
Order Transmission Methods
-
Paper requisitions include:
- Requisitions submitted with specimens
- Faxed requisitions
-
Electronic orders include:
- KDL Pathology's web ordering portal (kdlpathology.labnexus.net)
- The provider's EMR, where bidirectional or unidirectional interfaces are available
- Orders entered by authorized clinical staff on behalf of the provider
- Electronic orders submitted through the KDL Pathology LABNEXUS portal are authenticated through secure, user-specific credentials and are attributes to both the ordering provider and the individual entering the order. System audit logs are maintained and available upon request.
Provider Responsibility and Medical Necessity
- The ordering provider affirms that each laboratory test ordered is:
- Based on the provider's evaluation of the patient
- Reasonable and necessary for the diagnosis or treatment of illness or injury
- Ordered in accordance with applicable Medicare regulations, National Coverage Determinations (NCDs), and Local Coverage Determinations (LCDs), including those issued by Novitas.
- Each order reflects the provider's contemporaneous intent at the time of service and is supported by documentation in the patient's medical record.
- The ordering provider retains responsibility for establishing and documenting medical necessity for all laboratory services ordered.
Documentation Requests
- The provider and/or facility will maintain complete and accurate medical records supporting:
- The clinical rationale for each test ordered
- The presence of signs, symptoms, or diagnoses supporting medical necessity
- The provider's intent to order the test
- Such documentation must be available to KDL Pathology LLC, and to any authorized payer, including Medicare contractors, upon request.
Audit and Records Availability
- The provider and/or facility agrees to furnish, upon request:
- Medical records support the services ordered
- Documentation demonstrating provider authorization and intent
- Any additional information required for claims review, audit, or investigation by Medicare Administrative Contractors (including Novitas), commercial payers (including UHC and BCBS), or their designated review entities
- The provider acknowledges that failure to maintain or provide sufficient documentation may result in claim denial or recoupment.
Authorized Personnel (Designated Staff Members*)
Only clinical personnel authorized by the ordering provider and/or facility may transmit laboratory orders on the provider's behalf. Authorized personnel may include specific individuals or defined roles (e.g., medical assistants, nurses, or other clinical staff) as determined by the provider.
The provider and/or facility is responsible for:
- Defining which personnel are authorized to place orders
- Maintaining a current list or role-based designation of authorized users
- Ensuring that only authorized personnel access ordering systems
Documentation of authorized personnel must be maintained by the facility and provided upon request.