Electronic claims submission: Clinical Laboratory Improvement Amendments

The Centers for Medicare & Medicaid Services (CMS) regulates all laboratory testing in the United States through the Clinical Laboratory Improvement Amendments (CLIA). The objective of the CLIA program is to ensure quality laboratory testing.

 

Starting October 1, 2020, Anthem implemented a new CLIA edit.  Providers must submit a valid CLIA Certificate Identification number (#) for clinical laboratory services subject to the CLIA 1988 federal statute and regulations. 

 

This edit began returning as a warning only on October 1, 2020. Below is the edit that will return on your electronic claim report.

 

Edit 60119 - Clinical Laboratory Improvement Amendment (CLIA) Number is required for the technical component of this laboratory test.

 

On December 3, 2020, the edit will change from a warning to a rejection. Anthem will require that a valid CLIA Certificate Identification number is included on each claim billed for laboratory services subject to CLIA legislation.

 

Please contact your clearinghouse or software vendor to ensure the necessary changes are complete by December 3, 2020, to avoid electronic claim rejections.

 

How to apply for a CLIA Certificate:

https://www.cms.gov/Regulations-and-Guidance/Legislation/CLIA/How_to_Apply_for_a_CLIA_Certificate_International_Laboratories

 

For detailed information on the tests subject to CLIA, please refer to the CMS link below:

https://www.cms.gov/Regulations-and-Guidance/Legislation/CLIA/                   

 

760-1120-PN-VA