by Jared Staheli
July 10th, 2015
Effective with services provided October 1, 1997, any independent laboratory performing tests covered by CLIA must submit the CLIA number on the claim as provided below. The CLIA number is reported in:
• ASC X12 837 professional claim format REF segment as REF02, with qualifier of “X4” in REF01, or
• Field 23 of the paper CMS-1500.
The CLIA number is not required on the ASC X12 institutional claim data set or its related paper Form CMS-1450.
See Chapter 26 for detailed format instructions for the paper claim CMS-1500.
Laboratory claims submitted without the required CLIA number are returned as unprocessable. If the CLIA number is submitted on the claim, but is inconsistent with the CLIA format, the A/B MAC (B) returns the claim as unprocessable.
If more than one CLIA number is submitted on the claim, except when a reference laboratory is on the same claim, the A/B MAC (B) returns the claim as unprocessable. If the tests on one claim have been performed in more than one Physician Office Laboratory (POL) by the same physician, the appropriate CLIA number should be associated with the test that was performed in each laboratory. In such a case, the physician must submit a separate claim for each location (CLIA number) where a test was performed.