Add or Remove CLIA Number

This rule will add or omit the CLIA number on professional claims. It is important to note that both the CLIA number and Authorization number occupy Box 23 when present on a CMS-1500. As a result, if the patient has a standalone authorization number, the claim cannot display the CLIA number.

Workflow

Let's review how to create a claim rule to add or omit the CLIA number on professional claims!

• 1. Navigate to Management Center > Claim Rules.
     
     
  2. Click Create Claim Claim Form Rule.
     
  3. Select the Practice.
     
  4. Next, give the rule a name.
  5. Update the Claim Type to Professional.
     
  6. Select Conditions to create criteria a claim should meet before the rule will apply.
     
  7. Next, click on the Behaviors dropdown.
  8. Select Facility - CLIA Number.
     
  9. Next, click Add.
     
  10. Update the dropdown to one of the following:
      1. Authorization - Require and Write to require the standalone authorization number.
      2. Authorization - Write If Present to include the standalone authorization number when present. 
      3. CLIA Number - Require and Write to require the CLIA number.
      4. CLIA Number - Write If Present to include the CLIA number when present. 
      5. Omit to create the claim without the standalone authroization number or CLIA. 
         
  11. To create multiple behaviors, repeat steps 7-10.
  12. Click Save to complete the process.
       

Box Number(s)

• UB-04: N/A
• CMS-1500: Box 23 - Prior Authorization

Helpful Hints

• If one of your conditions is payer-based, select Current Sequence Behavioral instead of the Primary Behavioral Payer. This will ensure the rule applies to secondary and tertiary claims when needed. 
• To read more about how to set claim rule conditions and order, see the Claim Rule: Setting Claim Rule Conditions article.
• To read more about how to set up a claim rule to be effective as of a certain date, see the Scheduled Change Sets article.