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Reminder: CLIA Number Required for Specific Services

Date: 09/10/20

Effective August 1, 2019 Louisiana Department of Health required all Medicaid providers to include a valid Clinical Laboratory Improvement Amendments (CLIA) number on all professional services and independent laboratory services, including CLIA waived tests.  Claims submitted with an absent, incorrect , expired, and/or invalid CLIA number will deny.  CLIA number is not required for UB-04 claims.
 
Our system reads directly from the CMS Provider of Service (POS) CLIA file to validate CLIA information.  CMS updates this file every three months.  To ensure your claims process correctly and the POS files are current, we strongly advise that providers proactively submit an updated CLIA certification three months prior to the CLIA certification expiration date.  CMS regulates all laboratory services and testing performed on humans in the U.S.  The CLIA form, instructions and additional information can be found at CMS.gov.
 
Example of valid CLIA number formatting:  X419DXXXXXXX

  • The first two numbers must include the “X4” qualifier, 
  • The 19D characters represent the two-digit state code followed by the letter D, 
  • The remaining seven digits are the unique CLIA system number assigned to the provider 

CLIA certification number should be included in Box 23 of the CMS-1500 claim form or in the 2300 loop of an electronically billed claim form.  Providers can refer to the CMS-1500 Billing Instructions under the ‘Billing Information’ link at www.lamedicaid.com for complete instructions.
 
The laboratory services rendered should be appropriate for the certification level of the CLIA number indicated on the claim and the CLIA number must be active on the most recent CMS POS file on the date the services were rendered.  LHCC strongly encourages providers to update CLIA certification expiration information at least three months prior to the CLIA certification expiration date.  If your CLIA certificate is renewed after the posting of the CMS POS file, then claims will deny until the CLIA certificate is listed as active on the next CMS Provider of Services file.
 
For additional information providers can review Informational Bulletin 19-8.