Sunday, June 5, 2011

CLIA required MA 120, 130, CO B7 denial code and action

CLIA Certification Number Required - Denial COde MA120, MA130


Remark Code/ Message Number:

MA120: Missing/incomplete/invalid CLIA certification number

MA130: Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.

Resolution

• Entities that perform clinical laboratory tests must obtain certification through the state department of health. This is known as Clinical Laboratory Improvement Amendments of 1998 (CLIA) certification.

• Your CLIA number must be submitted on claims for clinical laboratory tests, including tests that are classified as 'CLIA-waived.' Submit this information in Loop 2300 or 2400, REF/X4, 02 for electronic claims. For paper claims, submit the CLIA certification number in Item 23 of the CMS-1500 claim form.

      o Some clinical laboratory tests must also be submitted with HCPCS modifier QW. The Food and Drug Administration     (FDA) determines which laboratory tests are waived. Please note that not all CLIA-waived tests require HCPCS modifier QW.

• Determine if the CPT code is a waived test by accessing the CMS CLIA Web page

• Palmetto GBA will publish information on tests newly classified as 'waived' on our Web site

• Submit your corrected claim as a new claim. Claims that are missing required CLIA certification numbers are rejected as 'billing errors' and must be submitted as new claims.

CLIA Background:

• The Centers for Medicare & Medicaid Services (CMS) regulates laboratory testing through CLIA. The primary objective of the CLIA program is to ensure quality laboratory testing. CLIA regulations require facilities to be appropriately certified for each test they perform.

• CLIA requires all facilities that perform even one test, including waived tests, on materials derived from the human body for the purpose of providing information for the diagnosis, prevention or treatment of any disease or impairment of, or the assessment of the health of human beings to meet certain Federal requirements

• Any facility that performs tests for these purposes, including physician office laboratories, are considered laboratories under CLIA and must apply for and obtain a certificate from the CLIA program

• New waived tests are approved by the FDA on a flow basis, and the tests are valid as soon as they are approved


CLIA: Laboratory Tests


Denial Reason, Reason/Remark Code(s):

CO-B7: This provider was not certified/eligible to be paid for this procedure/service on this date of service CPT codes include 82947 and 85610


Resolution

HCPCS modifier QW must be submitted with certain clinical laboratory tests that are waived from the Clinical Laboratory Improvement Amendments of 1988 (CLIA) list. The Food and Drug Administration (FDA) determines which laboratory tests are waived.


Note: Not all CLIA-waived tests require HCPCS modifier QW

Determine if the CPT code is a waived test by accessing the CMS CLIA web page

Palmetto GBA will publish information on tests newly classified as 'waived' on our website. Please note, the list of CLIA-waived procedures is updated as often as quarterly.

The CLIA certificate number is also required on claims for CLIA waived tests. Submit this information in Loop 2300 or 2400, REF/X4, 02 for electronic claims. For paper claims, submit the CLIA certification number in Item 23 of the CMS-1500 claim form.

Access complete instructions for correctly submitting HCPCS modifier QW in the Palmetto GBA Modifier Lookup tool.

Generally, CLIA certification is required for each location where testing is performed. There are exceptions for laboratories that are not at a fixed location and laboratories within a hospital. Refer to CMS CLIA Brochure #5 named How to Obtain a CLIA Certificate for more details about exceptions to the 'location rule'

2 comments:

  1. State-of-the-art methodical advances throughout diamond components to be able to related, usually besting, the features of your mined gemstones include ended in a benefit to be able to beleaguered diamond jewelry enthusiasts. Truckers InsuranceBrand new lab-created gemstones are generally so near to mined gemstones that simply a qualified eye could identify each, usually needing a microscope or even loupe.

    ReplyDelete
  2. This is very important post about a driver. A driver need to making a insurance. But must be need a helmet.Visit hereFor helmet. Here are a couple tips you can think seriously about when purchasing a head protector.

    ReplyDelete

Popular Posts