What is a CLIA Number?
A CLIA (Clinical Laboratory Improvement Amendment) number is a unique identifier required for certain laboratory tests. It's essential for proper claim submission and reimbursement.
When is a CLIA Number Required?
CLIA numbers are required for specific laboratory tests, as determined by the Centers for Medicare & Medicaid Services (CMS). These typically include tests listed on the CMS Clinical Laboratory Fee Schedule.
How is a CLIA Number stored?
CLIA numbers can be stored in the Location Settings of locations on DocStation, or in the details of Contacts created from Organization Settings.
Location Settings
Click the Settings cog
Click the Locations tab
Select the applicable location
Scroll to the CLIA number section
Enter the CLIA number for the Location
Contact details
Click the Settings cog
Click the Contacts tab
Select the applicable contact, or create a new contact from the + in the top right corner
Enter the CLIA number for the contact
How to Use CLIA Numbers in Claims
1. Selecting a CLIA Facility
When creating a claim that includes CLIA-required tests:
Choose the appropriate CLIA facility from the dropdown menu in the claim.
This facility can be either a location within your organization or an external laboratory, which can be listed in Contacts.
2. Understanding Modifiers
The system will automatically apply the correct modifier based on your CLIA facility selection:
QW modifier: Applied when the CLIA facility is the same as the Billing Provider.
90 modifier: Applied when the CLIA facility is an "outside lab" (i.e., a Contact).
3. Common Scenarios
Scenario 1: Internal CLIA Facility
If you select an organization location with a CLIA number as both the Billing Provider and CLIA Facility, the location's CLIA number will be added to the claim.
For Medicare claims, the QW modifier will be added to each CLIA service line.
Scenario 2: External CLIA Facility
If you select an external contact as the CLIA Facility, no CLIA number will be added to the claim.
The 90 modifier will be added to each CLIA service line.
Scenario 3: Different Internal Location
If you select a different organization location as the CLIA Facility, the system will determine if it's internal or external based on its tax ID.
The appropriate modifier (QW or 90) will be applied accordingly.
Troubleshooting
If you receive a validation error stating that a CLIA number is required, ensure that the selected CLIA facility has a valid CLIA number entered in the system.
Need Help?
If you have any questions or encounter issues with CLIA numbers in your claims, please contact our support team for assistance.