455 = Last X-ray date. 2400. on-one assistance to ensure the CLIA number is transmitting in the required electronic data format. Enter the star of this post: the CLIA number. DTP03. CLIA recommends that agents generate a minimum of $5,000 in total agency commissions from cruise bookings within the 12 months prior to enrollment. Note: The CLIA number for the referring clinical laboratory should be included in REF (F4). The Edit Service Location page opens. CLIA numbers began issuing accreditation numbers in 2000. • ANSI 5010 E-claim Crosswalk In loop 2300, Segment REFO2, enter the CLIA Certification number (Do not enter “CLIA” with the certificate number as this will cause claims to deny as an invalid identification number). 19 (cont) Demonstration ID. Location(s) Reserved for Procedure Modifier and CLIA # Modifier QW – diagnostic lab service is a CLIA waived test Date format qualifier. Referral laboratory claims are permitted only for independently billing clinical laboratories, specialty code 69. For reference laboratory claims, two CLIA numbers must be submitted. 2300. or. Note: The CLIA number must be uppercase and in the following 10-digit format: 11D1111111. Repeat steps 2-4 if there are multiple service location that requires a CLIA number. Demonstration ID – number. The CLIA number must be entered in block 23 of Form CMS-1500 or the applicable electronic field. Two subsequent amendments were made after 1988. CLIA supports policies and practices that foster a safe, secure, healthy and sustainable cruise ship environment and is dedicated to promoting the cruise travel experience. Date format qualifier. Agents could transition their old ARC/IATA number into a CLIA number or (like keeping your same phone number but switching to a new carrier). Date last seen. DTP03. REF01. The following examples illustrate how the CLIA number, as well as procedure code modifiers QW and 90, should be submitted: Claim Format. Populate the CLIA Number field. Or, for agents without an ARC/IATA number, CLIA would issue a them a brand-spanking-new CLIA number. The following information is required to be included (CLIA regulations, Subpart K, 493.1211): ... Use a three-ring binder to maintain the document in a format that is easily reviewed and updated. 2300. Double-click on the service location that needs the CLIA number. Established in 1975, Cruise Lines International Association (CLIA) is the world’s largest cruise industry trade association, providing a unified voice and leading authority of the global cruise community. Date assumed or relinquished care. Chiropractor. Clia number in CMS 1500 On each claim, the CLIA number of the laboratory that is actually performing the testing must be reported in item 23 on the CMS-1500 form. To qualify for CLIA Individual Agent Membership (IAM), your affiliated agency must be a current CLIA Travel Agency Member. The billing laboratory CLIA number must be submitted in a REF segment in the 2300 loop with an X4 qualifier and the reference laboratory CLIA number (the CLIA number for the lab who performed the service) must be submitted in a REF segment in the 2400 loop with an F4 qualifier. The CLIA number must be on all claims for laboratory services, or the claim will be returned as un- process able. Date / Time qualifier. DTP01. The Clinical Laboratory Improvement Amendments of 1988 statute is an amendment to the Public Health Services Act in which Congress revised the federal program for certification and oversight of clinical laboratory testing. The CLIA Number is reported in: ASC X12 837 professional claim format Ref Segment as REF02 with qualifier of “X4” in REF01 or Field 23 of the paper CMS-1500 DTP02. The law continues to be cited as CLIA ’88 as named in legislation. Reference identification qualifier (P4 = Project code) REF02. Click Save.