MA120: Missing/incomplete/invalid CLIA certification number
On Call Scenario:
Claim denied for missing or invalid CLIA Number↓
May I get the denial date?
↓
Checked on box 23 of claim form, CLIA number is available or not? /
Checked in the system if CLIA number is available?
↙ ↘
Yes No
↙ ↘
Yes No
↓ ↓
We have already billed the claim with CLIA number, ↓
can you please check whether Is it correct or not? / ↓
I have the CLIA number, can you please check ↓
whether Is it correct or not? ↓
↙ ↘ ↓
Yes No ↓
↓ ↘ ↓
Can you please reprocess the claim? Can you please provide the correct CLIA number?
↓ ↙ ↘
Rep agrees? Rep provides correct Rep denies to provide
↙ ↘ CLIA number correct CLIA number
Yes No ↓ ↓
↙ ↘ What is the time frame Search on below 2 links of
What is the TAT What is to submit corrected claim? CDC & CMS to find out
for reprocessing? the reason? ↓ correct CLIA code and verify
↘ ↙ May I have the with rep, Is that correct or not?
May I have the claim# & call ref#? claim# & call ref#? ↙ ↘
If it is correct If unable to locate CLIA
↘ number or facility name
↘ ↙
What is the time frame
to submit corrected claim?
↓
May I have the
claim# & call ref#?
Important Note:
- If the rep has provided the correct CLIA code then update it in your software or on clearing house and resubmit the corrected claim.
- If you do not have access to update the CLIA number on the software or clearing house then assign it to the client for assistance. If your client has already provided the instructions for this scenario then work accordingly.
- CLIA number can be found on below 2 websites. On the CDC portal, you can search for CLIA by CLIA number or Laboratory Name (Facility or Group Name) and on the CMS portal, CLIA number can be searched using CLIA number, Facility Name, or Facility Address.
- CDC Portal: https://www.cdc.gov/clia/LabSearch.html
- CMS Portal: https://qcor.cms.gov/advanced_find_provider.jsp?which=4&backReport=active_CLIA.jsp
- There could be multiple CLIA numbers under the same facility, in such cases try to match the address of the facility and find out the correct CLIA number.
- If you are unable to locate the facility on both websites, it means that the facility is not CLIA certified then assign it to the client for assistance.
- CLIA Waived test needs to be billed with the QW modifier along with the CLIA number. For more details on CLIA, Click Here
inccoret
ReplyDeleteCdc full form
ReplyDeleteIts a portal to search CLI number.
DeleteClia denial what is clia,why getting denial
ReplyDeleteIt is needed for Lab codes, you can find more information on below post.
Deletehttps://www.arlearningonline.com/2021/06/clia-clinical-laboratory-improvement.html