Where to input CLIA#?

[Blackhorse]

We put CLIA# in the box 23 on the CMS-1500 but the claim is denied by Medicare. We are told that the CLIA# was incorrectly put in the prior authorization box. Is it the same box to put Auth# or CLIA#? We are told to use X4 modifier, do we add X4 at the end of the CLIA#?

 

[trarut]

According to the Medicare manual, the CLIA is reported in Box 23. The X4 isn't a modifier, it's a qualifier and it tells the electronic claims system the type of data you're providing in that field. Your claims system should have a specific field where the CLIA number is entered and it should then be converted to the proper format for the electronic claim. This field may be in the payer master record or it could be in the charge entry window somewhere. I recommend checking your Medicare contractor's website for specifics on how to report the CLIA number to them and then talking to whomever administers your billing system internally or talking to the company directly to ensure the qualifier is being reported correctly on your claims.

 

[Blackhorse]

According to the Medicare manual, the CLIA is reported in Box 23. The X4 isn't a modifier, it's a qualifier and it tells the electronic claims system the type of data you're providing in that field. Your claims system should have a specific field where the CLIA number is entered and it should then be converted to the proper format for the electronic claim. This field may be in the payer master record or it could be in the charge entry window somewhere. I recommend checking your Medicare contractor's website for specifics on how to report the CLIA number to them and then talking to whomever administers your billing system internally or talking to the company directly to ensure the qualifier is being reported correctly on your claims.

Thank you so much.