Responsibility of Provider Where Benefits May be Payable Under the Federal

30.2.3 - Responsibility of Provider Where Benefits May be Payable Under the Federal Black Lung (BL) Program (Rev. 11874, Issued: 02-23-23, Effective: 03-24-23; Implementation: 03-24-23) Providers are to identify beneficiaries who may be entitled under the Federal Black Lung (BL) Program. Where it appears that a beneficiary may be entitled to receive medical benefits under the Federal BL Program administered by DOL, the provider bills DOL in the following situations: • Diagnosis Is BL Related (which includes a diagnosis that is related to BL within the family of ICD diagnosis codes) - The provider bills all services to DOL, and includes its DOL assigned provider number on the billing form. • Diagnosis Is Not BL Related - The bill is for an inpatient stay during which some BL covered procedures were furnished. The provider bills all services to DOL. • The bill is for outpatient services that include one or more BL related procedures. The provider bills DOL only for those procedures that are reimbursable under the BL program. • DOL Does Not Pay for All of the Services - If a provider bills DOL, but DOL doesn't pay for the services in full, the provider bills Medicare as provided in Pub. 100-04, Chapter 25, "Completing and Processing the Form CMS 1450 Data Set," attaching a copy of DOL's denial notice which gives the specific reason for nonpayment. If a claim is denied because of the provider's failure to obtain a DOL provider number or to furnish documentation needed by DOL, payment may not be made under Medicare.