Clinical Laboratory

Medical Coverage Guidelines

Please note that coverage guidelines and procedures are subject to change. Refer to the monthly Provider Update for more information.

• Clinical Laboratory Provider Reference Manual  

Claim Preparation Instructions

• CMS 1500 Form Filing Instructions 
• Clinical Laboratory Services – CSM 1500 Claim Form 

Error Status Codes

• ESC Code List (English) 

Explanation of Benefits (EOB) Codes

• EOB Codes and Messages List (English) 
• EOB Codes and Messages List (Spanish) 

Appendix - Third Party Liability Carrier and Coverage Codes

• Third Party Liability (TPL) Carrier Codes 
• Third Party Liability (TPL) Coverage Codes 

For questions please contact the DXC Technology Customer Service Help Desk at (401) 784-8100 for In-state and long distance callers, or 1-800-964-6211 for In-state toll callers and border communities.