Claim edit: Missing CLIA number for a lab test
Stedi now rejects 837P professional claims that bill a lab test without a Clinical Laboratory Improvement Amendments (CLIA) number.
Lab tests and CLIA numbers
A CLIA number identifies a lab that's certified to test human specimens. Payers require the number on claims that bill lab tests.
A service line reports the lab test as a procedure code.
Procedure code
| Claim type | JSON API field | X12 element |
|---|---|---|
| 837P professional | Claim Submission API: claimInformation.serviceLines[].professionalService.procedureCodeCMS-1500 API: serviceLines[].procedureCode.code | SV1-01-02 (Procedure Code) of Loop 2400 (Service Line) |
You can report the CLIA number at the claim level or on individual service lines.
Claim-level CLIA number
| Claim type | JSON API field | X12 element |
|---|---|---|
| 837P professional | Claim Submission API: claimInformation.claimSupplementalInformation.cliaNumberCMS-1500 API: encounter.referenceNumbers.clia | REF-02 (Reference Identification) of Loop 2300 (Claim Information) |
Line-level CLIA number
| Claim type | JSON API field | X12 element |
|---|---|---|
| 837P professional | claimInformation.serviceLines[].serviceLineReferenceInformation.clinicalLaboratoryImprovementAmendmentNumber | REF-02 (Reference Identification) of Loop 2400 (Service Line) |
How the edit works
The Centers for Medicare & Medicaid Services (CMS) lists lab test procedure codes in the Clinical Laboratory Fee Schedule (CLFS). Stedi checks each service line's procedure code against the CLFS for the line's service date.
If a line bills a lab test and has no CLIA number at either level, the payer may reject the claim. CLIA-waived tests still need a CLIA number.
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
How you get the error depends on how you submit the claim.
If you submit a claim using the Create Professional Claim (CMS-1500) JSON endpoint and the claim fails the edit, you'll get back a 201 response with an errors array in real time:
{
"errors": [
{
"description": "Missing CLIA Number. A Laboratory Test was billed on line 1, 87811, which requires a Clinical Laboratory Improvement Amendment (CLIA) number. This can be included at the claim or line-level. Correct and resubmit."
}
]
}If you submit a claim using Stedi's other 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": "Missing CLIA Number. A Laboratory Test was billed on line 1, 87811, which requires a Clinical Laboratory Improvement Amendment (CLIA) number. This can be included at the claim or line-level. 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*A6>544**U*********Missing CLIA Number. A Laboratory Test was billed on line 1, 87811, which requires a Clinical Laboratory Improvement Amendment (CLIA) number. This can be included at the claim or line-level. Correct and resubmit.~Related claim edits
Stedi has another edit for CLIA numbers in an invalid format. See Invalid CLIA number format.