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The Clinical Laboratory Improvement Amendments of 1988 is federal legislation with the objective of ensuring quality laboratory testing. It applies to any facility or individual Provider that performs laboratory services and wants to receive payments under Medicare and Medicaid programs.

Fidelis Care will continue to uphold the Federal and State guidelines to ensure laboratory claims submitted by providers meet these requirements:

• A valid CLIA certificate for the type of tests performed at each location
• An active CLIA certificate
• Exceptions are based on both NYS and CMS Regulations         

Providers should submit their CLIA number on the claim as follows:

• Electronic Claim: Loop 2300, REF01 = X4, REF02
• Paper Claim (CMS 1500): Field 23
• If there are multiple items in Box 23, the provider should include a hyphen (-) or semicolon (;) between the items

For more information visit:

• Centers for Medicare and Medicaid Services CLIA Information - https://www.cms.gov/medicare/quality/clinical-laboratory-improvement-amendments/apply
• Fidelis Care CLIA Tip Sheet

If you have any additional questions, or if we can be of assistance in any way, please contact your Fidelis Care Provider Engagement Account Manager. To identify your designated representative, please visit Contact Your Designated Provider Relations Specialist.