Remark code MA120 indicates that the claim submitted lacks a valid Clinical Laboratory Improvement Amendments (CLIA) certification number, or the number provided is incomplete or incorrect. The CLIA certification number is essential for laboratory billing, and without it, the claim cannot be processed. This remark code serves as a notification to the healthcare provider to provide the correct CLIA number in order to facilitate claim adjudication.
Common causes of code MA120 are:
1. The laboratory test was performed without a valid Clinical Laboratory Improvement Amendments (CLIA) certification number being provided on the claim.
2. The CLIA number provided on the claim is incorrect or has been entered with typographical errors.
3. The CLIA certification has expired, and the laboratory has not renewed it in time for the date of service on the claim.
4. The claim was submitted with a CLIA waiver number when a full CLIA certification number was required for the complexity of the test performed.
5. The claim lacks the necessary CLIA number because it was omitted during the billing process, possibly due to oversight or a breakdown in the internal communication process between the laboratory and the billing department.
6. The CLIA number provided does not match the National Provider Identifier (NPI) or the Tax Identification Number (TIN) associated with the performing laboratory, leading to a mismatch in the payer's system.
7. The test performed falls under a category that requires a specific type of CLIA certification, and the laboratory has a different type of certification that does not cover the test in question.
8. The billing software or clearinghouse used to submit the claim may have a glitch or error that caused the CLIA number to be dropped or incorrectly formatted on the claim.
Ways to mitigate code MA120 include ensuring that the Clinical Laboratory Improvement Amendments (CLIA) certification number is accurately recorded on all lab test claims before submission. Regularly verify that the CLIA number is current and has not expired. Implement a system to double-check that the number is complete and correctly formatted according to the standards required by the payer. Additionally, train billing staff to recognize and correct CLIA-related errors during the claim preparation process.
The steps to address code MA120 involve verifying the Clinical Laboratory Improvement Amendments (CLIA) certification number for accuracy. First, review the laboratory test order to ensure the CLIA number was included on the claim. If it was omitted, obtain the correct CLIA certification number from the laboratory's records or the ordering provider and resubmit the claim with the number included. If the number was included but reported as invalid, double-check the number against the laboratory's official CLIA certificate for any discrepancies. Correct any errors found and resubmit the claim with the accurate CLIA number. If the number is correct but the claim was still denied, contact the payer to clarify the reason for the denial and to confirm the CLIA number is on file and recognized as valid. If necessary, provide a copy of the CLIA certificate to the payer as proof of certification and request reprocessing of the claim.