This information pertains to Anthem HealthKeepers Plus providers.

 

Effective October 1, 2019, HealthKeepers, Inc. implemented the edits for Clinical Laboratory Improvement Amendments of 1988 (CLIA).

 

As a reminder, if you were issued a Certificate of Waiver type of CLIA Certificate, you can only perform specific waived tests.

 

If you are unsure of what your certificate level is, please refer to the Laboratory Demographics Lookup at https://tinyurl.com/Laboratory-Demographics-Lookup.

 

The CLIA number needs to be included on the claim. In addition, the service address must match the address of record noted on the CMS Provider of Service File.

 

If you receive a GLI denial, it means that the CLIA number is missing on the claim, or your service address is not matching the address on file with CMS. The first three characters of the address in CMS are compared with the billing and servicing address on the claim to try to make a match. This is to ensure that each location is registered with their own CLIA number.

 

If you receive a GLJ denial, it indicates that the level of certification of the CLIA submitted on the claim is not a high enough level for the procedure being billed.

 

Please refer to the below links for additional information regarding CLIA edits.

 

List of waived tests:

https://tinyurl.com/categorization-of-tests

 

General information and FAQ:

https://tinyurl.com/CLIA-FAQ

 

How to obtain a CLIA Certificate:

https://tinyurl.com/CLIA-Certificate

 

If you have any questions about this communication, call Provider Services at 1‑800‑901‑0020 or Anthem CCC Plus Provider Services at 1‑855‑323‑4687.

 

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Featured In:
September 2020 Anthem Provider News - Virginia