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Get paid faster for lab claims

Last modified: Oct. 12, 2022

If a lab test is billed and it does not match the level of Clinical Laboratory Improvement Amendment (CLIA) certification, we will let you know through a Smart Edit on your 277CA clearinghouse rejection report so you can respond- speeding up claims processing so you get paid faster.  Please refer to the Smart Edits Homepage.

5 levels of CLIA certification:

  1. Certificate of Waiver
  2. Certificate for Provider-Performed Microscopy Procedures (PPMP)
  3. Certificate of Registration
  4. Certificate of Compliance
  5. Certificate of Accreditation

If your certification level is a certificate of waiver, you may only bill tests granted under waived status.

The use of the QW modifier may be necessary when billing a CLIA waived test with Waiver or PPMP/Microscopy level certification. When there are situations like an Emergency Use Authorization (EUA), additional tests may be deemed as CLIA waived tests and also require the QW modifier.

Information on these additional codes can be found through Centers for Medicare and Medicaid Services (CMS) transmittals and Medicare Learning Network (MLN) Matters articles on the CMS website.

Questions?

PCA# 1-21-01974-PI-News