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Back  RFI # 1742: Service Level CLIA - 837P

Formal vs. Informal Help Informal Formal

Submitter

Marshall Dunbar

Description

Payer is rejecting claim for 'Lab procedures with different CLIA certification numbers must be billed on seperate claims". I thought the note on Loop 2300 REF*X4 and on Loop 2400 REF*X4 would allow multiple CLIA certification within a claim.
Do I need to no longer use Loop 2400 REF*X4 ?

Response

The 5010 837 Professional TR3 does support multiple CLIA numbers on a single claim. One CLIA number would be reported in the claim level REF segment, and additional CLIA numbers that are different than the claim level CLIA number would be reported in service line REF segments.

A restriction of one CLIA number per claim is not consistent with the TR3. Also, such a restriction in the case of secondary claims would be a problem for COB claims where the primary payer accepted multiple CLIA numbers. The provider could not submit the secondary claim as adjudicated by the primary payer.
Submission 1/30/2013
Status Date 3/20/2013
Status F - Final
Primary References
Document 005010X222
Section1.1