Account receivables - CLIA and QW modifiers

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, which even applies to 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.

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.
CLIA-waived procedures that do not require HCPCS modifier QW include:
CPT codes: 81002, 81025, 82270, 82272, 82962, 83026, 84830, 85013, 85651
HCPCS code: G0394
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.
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
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

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 Web site. 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.

Links which are simillar to
http://billingatchennai.blogspot.com/2008/09/medicare-top-ten-denials-and-action_19.html

2 comments:

Dr Guptha said...

Get the Information from the cms.hhs.gov

medical coding training

Dr Guptha said...

Hi, Very nice information.
Consider getting ICD10 Training at the earliest. there will be more demand for the ICD10 Coders.

ICD10 Certification

Medical Billing Popular Articles