Claim edit: Invalid CLIA number format

Stedi now rejects 837P professional claims that report a Clinical Laboratory Improvement Amendments (CLIA) number in an invalid format.

What is a CLIA number?

A Clinical Laboratory Improvement Amendments (CLIA) number identifies a lab authorized to test human specimens. CLIA is a federal laboratory regulatory program administered by the Centers for Medicare & Medicaid Services (CMS) and applies to the operation of the laboratory. Medicare and Medicaid claims that bill for lab services require this number. Most other payers have the same requirement.

You can specify CLIA numbers at the claim level or on individual service lines.

Claim-level CLIA number

Line-level CLIA number

How the edit works

Each CLIA number is 10 characters with a fixed NNDNNNNNNN format: a two-digit state code, the literal D, then a seven-digit facility and check identifier.

If one or more CLIA numbers in a professional claim don’t follow this format, the payer may reject the claim.

This edit catches the issue before the claim reaches the payer. It prevents payer rejections, which take longer to resolve and delay payment for the provider.

Rejection errors

If you submit a claim using Stedi's Claim Submission API endpoints and the claim fails the edit, you'll get back an error response in real time. The response includes details in the errors array:

{
  "errors": [
    {
      "code": "33",
      "description": "Invalid CLIA Number. A valid CLIA number must be 10 characters with position 1-2 being the numeric state code, position 3 must be 'D', and positions 4-10 must also be numeric. The submitted value, 45X2167451, is not valid. Correct and resubmit.",
      "followupAction": "Please Correct and Resubmit"
    }
  ]
}

{
  "errors": [
    {
      "code": "33",
      "description": "Invalid CLIA Number. A valid CLIA number must be 10 characters with position 1-2 being the numeric state code, position 3 must be 'D', and positions 4-10 must also be numeric. The submitted value, 45X2167451, is not valid. Correct and resubmit.",
      "followupAction": "Please Correct and Resubmit"
    }
  ]
}

{
  "errors": [
    {
      "code": "33",
      "description": "Invalid CLIA Number. A valid CLIA number must be 10 characters with position 1-2 being the numeric state code, position 3 must be 'D', and positions 4-10 must also be numeric. The submitted value, 45X2167451, is not valid. Correct and resubmit.",
      "followupAction": "Please Correct and Resubmit"
    }
  ]
}

If you submit a claim using SFTP and the claim fails the edit, Stedi will reject the claim with a 277CA claim acknowledgment. The acknowledgment will include a related claim status category code, claim status code, and error message:

STC*A7>544*[DATE]*U*[AMOUNT]********Invalid CLIA Number. A valid CLIA number must be 10 characters with position 1-2 being the numeric state code, position 3 must be 'D', and positions 4-10 must also be numeric. The submitted value, 45X2167451, is not valid. Correct and resubmit

STC*A7>544*[DATE]*U*[AMOUNT]********Invalid CLIA Number. A valid CLIA number must be 10 characters with position 1-2 being the numeric state code, position 3 must be 'D', and positions 4-10 must also be numeric. The submitted value, 45X2167451, is not valid. Correct and resubmit

STC*A7>544*[DATE]*U*[AMOUNT]********Invalid CLIA Number. A valid CLIA number must be 10 characters with position 1-2 being the numeric state code, position 3 must be 'D', and positions 4-10 must also be numeric. The submitted value, 45X2167451, is not valid. Correct and resubmit