Test: New Billing Requirement


DATE:                    March 2, 2017

TO:                        Iowa Medicaid Independent Laboratories

APPLIES TO:         Managed Care, Fee-for-Service  

FROM:                   Iowa Department of Human Services (DHS), Iowa Medicaid Enterprise (IME)

RE:                        New Billing Requirement - Clinical Laboratory Improvement Amendments (CLIA) Certification Number on Claims

EFFECTIVE:           April 1, 2017

There are new requirement applicable to Independent Laboratories (Labs), as it relates to the CLIA certification number that is to be used on claims submitted to the IME and  Managed Care Organizations (MCOs) for Medicaid members. This new requirement is effective with dates of service on/after April 1, 2017. The IME is making this change to be consistent with how Medicare requires labs to bill for services and applies to claims submitted on either a CMS 1500 or HIPAA 5010 837 claim form.

All claims for laboratory services must include the CLIA number for the servicing provider. The laboratory servicing provider physical address will also be required if the address differs from the billing provider address noted on the claim. The billing or servicing provider address must match the address associated with the CLIA ID number.


Letter #: 
Issue Date: 
2018-03-21 00:00:00
Effective Date: 
2018-03-21 00:00:00
Updated Codes: