Claims for Location Specific Practice Number (LSPN) for Medicare 012-41040050

This document outlines details regarding payment of LSPN claims for diagnostic imaging or radiation oncology services.

Patient claims submitted at a Service Centre

Table 1: this table describes how to process a patient claim for diagnostic or radiation oncology services in a Service Centre when the LSPN is not supplied.

Step	Action
1	Contact provider or practice + Read more ... Verify the LSPN for the date of service. Complete a VG4 form to record the details. Note: the VG4 form is for internal use only and must be kept in the Service Officer's batch envelope. The Resources page contains a link to the VG4 form.
2	Registered practice + Read more ... Is the practice registered? Yes, insert the LSPN, process and pay claim. Batch the declaration with the claim form and account or receipts. Go to Step 7 No, go to Step 3
3	Practice unidentifiable or not registered + Read more ... Where the practice is unable to be identified or is not registered, tell the claimant: 'This claim cannot be paid as the LSPN was not supplied on the account or receipt. Legislation requires that practices are registered with Medicare and their LSPN should always be quoted on all diagnostic imaging or radiation oncology accounts or receipts, for Medicare benefits to be payable. The provision of the LSPN makes sure the type of equipment used meets Medicare requirements. Under legislation, practices not registered need to tell patients at the time of service. This can be either a sign or in writing stating ‘Medicare benefits are not payable'.
4	Declaration form required + Read more ... Tell the patient or claimant they can complete a declaration form and submit the form to a Minister's delegate who will determine if payment can be made. Ask the patient or claimant to complete and sign the LSPN declaration form. The Resources page contains a link to the declaration form. Note: do not indicate if the payment will be made. Complete the office use only section on the LSPN declaration form.
5	Get signature and fax declaration + Read more ... Get a signature from either the Service Centre Manager or team leader indicating the claim is correct for payment and a valid benefit is payable if approved by the delegate. Place a comment in CDMS Personal ‘LSPN declaration form completed’. Email the completed declaration form to the Assessing and Benefits for consideration by the delegate. Phone Assessing and Benefits to tell them of the email (only use this phone number for this purpose). The officer then requests delegate approval.
6	Delegate approval outcome + Read more ... If approval is received, complete the appropriate section on the form and process a manual payment. If approval is denied: batch the declaration with the claim form and account or receipts tell the patient or claimant of the outcome

Claims submitted via post

Table 2: this table describes how to process a patient claim submitted via post for diagnostic or radiation oncology services when the LSPN is not supplied.

Step	Action
1	Get date of service + Read more ... Contact the provider or practice to verify the LSPN for the date of service Complete a VG4 form to record the details Note: the VG4 form is for internal use only and must be kept in the Service Officer's batch envelope. The Resources page contains a link to the VG4 form.
2	Registered practice + Read more ... If the practice is registered: Key the LSPN (preceded by an ‘L’ qualifier) in the FEE: field process and pay claim
3	Practice unidentifiable or not registered + Read more ... Where the practice is unable to be identified or is not registered: reject the claim using either RSN code 536 or 539 photocopy the claim and account/receipt and return the original claim form, /original account/ receipts and the LSPN declaration form (if practice is not registered) to the claimant, explaining why the Medicare benefit could not be paid providers can call the LSPN helpdesk to register The Resources page contains a link to the LSPN declaration form.
4	LSPN declaration received + Read more ... Where an LSPN declaration form is received via post, make sure all details are completed and the declaration form is signed. Complete the office use only section on the LSPN declaration form.
5	Get signature and fax declaration + Read more ... Get a signature from either the Service Centre Manager or a Team Leader indicating the claim is correct for payment and a valid benefit is payable if approved by the delegate. Place a comment in the CDMS Personal ‘LSPN declaration form completed’. Email the completed declaration form to Assessing and Benefits for approval by the delegate. Phone Assessing and Benefits to tell them of the email (only use this phone number for this purpose). The officer requests delegate approval.
6	Delegate approval outcome + Read more ... If approval is received, complete appropriate section of the form and process a manual payment. If approval is denied: batch the declaration with the claim form and account or receipts tell the patient or claimant of the outcome

Return message 1 LSPN REQ

Table 3: this table describes how to resolve return message 1-LSPN REQ for manual claims, online claiming and simplified billing. This return message displays when a diagnostic imaging or radiation oncology item is keyed with a date of service on or after 1 July 2003 when the LSPN is not entered (or required).

Step	Action
1	Check if LSPN is present + Read more ... If the LSPN is: present on the claim documents on (for manual claims) or in the text field (for online claiming), go to Step 2 not present on the claim documents (for manual claims) or in the text field (for online claiming) go to Step 3
2	Key LSPN + Read more ... key the LSPN (preceded by an L qualifier) in the FEE: field process and pay claim Procedure ends here.
3	Reject claim + Read more ... Reject item with reason code 536 (This service needs a LSPN).

Return message 1 LSPN #

Table 4: this table describes how to resolve return message 1-LSPN # for manual claims, online claiming and simplified billing. This return message displays when the LSPN keyed is invalid (incorrect format).

Step	Action
1	Check if valid LSPN is present + Read more ... If a valid LSPN is present on the claim documents (for manual claims) or in the text field (for online claiming), go to Step 2 not present on the claim documents (for manual claims) or in the text field (for online claiming) go to Step 3
2	Key LSPN + Read more ... key valid LSPN (preceded by an L qualifier) in the FEE: field. process and pay claim Procedure ends here.
3	Reject claim + Read more ... Reject item with reason code 537 (The service has an invalid LSPN).

Return message 1 LSPN NOT

Table 5: this table describes how to resolve return message 1-LSPN NOT for manual claims, online claiming and simplified billing. This return message displays when the LSPN keyed is not recorded on the LSPN register.

Step	Action
1	Check claim documents LSPN + Read more ... If the LSPN on the claim documents (for manual claims) or in the text field (for online claiming) is: not the LSPN keyed/transmitted/scanned on the screen, go to Step 2 is the LSPN keyed/transmitted/scanned on the screen, go to Step 3
2	Key LSPN + Read more ... key correct LSPN (preceded by an L qualifier) in the FEE: field process and pay claim Procedure ends here.
3	Reject claim + Read more ... Reject item with reason code 538 (the LSPN is not recorded on the LSPN Register).

Return message 1 LSPN REG

Table 6: this table describes how to resolve return message 1-LSPN REG for manual claims, online claiming and simplified billing. This return message displays when the site is not registered at the date of service.

Step	Action
1	Check claim documents LSPN + Read more ... If the LSPN on the claim documents (for manual claims) or in the text field (for online claiming) is: not the LSPN keyed/transmitted/scanned on the screen, go to Step 2 is the LSPN keyed/transmitted/scanned on the screen, go to Step 3
2	Key LSPN + Read more ... key correct LSPN (preceded by an L qualifier) in the FEE: field process and pay claim Procedure ends here.
3	Reject claim + Read more ... Reject item with reason code 538 (The LSPN is not recorded on the LSPN Register).

Operational Information