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CLIA denials

  1. #1
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    Default CLIA denials
    Medical Coding Books
    I keep getting denials only from United about Missing/incomplete/invalid CLIA certification number. I am new to billing and had called over to United but can not get an accurate answer. We are doing strep test along with any other tests in office. Any help?

  2. Default
    Has your CLIA certificate recently renewed? They may not have the new effective dates on file, causing your claims to deny. I would see if you can get a copy of the current CLIA certificate (your lab manager should have it) and then get in touch with your UHC provider rep and have them check it out on their end.

    Tracy
    Tracy
    CPC (2002), CPB (2015), CHONC (2015)

  3. #3
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    Thank you for responding, yes our CLIA is up to date. And I have called over to our provider rep and she can not seem to help.

  4. #4
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    Which strep test are you performing. 87880,QW and what other tests

  5. #5
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    It is mostly strep test and I've put the modifier as well, but I am still getting denials.

  6. #6
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    Quote Originally Posted by vickytia13 View Post
    It is mostly strep test and I've put the modifier as well, but I am still getting denials.
    is it commercial united, go to CMS Site and pull your clia certificate data is it still valid accurate etc. get a copy of your certificate and attach it to a United healthcare appeal form and submit the claim for appeal, also make sure the data is populating in the clia field on the hcfa I do know some selffunded Optum United's don't pay for rapid flu and strep together but that's not the rationale they give this sounds like your payer files haven't been updated and UHC has been requiring 30 or 60 day verification. thru the site.

  7. #7
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    then I would bypass my rep and appeal 2 or 3 on my own, attach the copy of the clia, make sure the clia info is appearing on the claim, make certain your brand of strep test is on the clia waived list, and appeal the claim, your aren't performing the newer back up strep culture confirmation test correct . I do know ATC wouldn't cover a rapid RST when performed in conjunction with the rapid Flu same date but the denial rational was different.
    UHC has been requesting provider data file updates every 30 -60 Days have you logged in to see if your Dr is in need of something.

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