CLIA Numbers are not loaded

Management and Administration
#1

juggernautsei wrote on Wednesday, May 20, 2015:

Hi All,

Demi our biller said:
“I went to create some claims today and when I reviewed them, I noticed that the CLIA numbers are still not loaded”.

I checked the facilities and the CLIA number in the field. How do we get it into the claims?

Windows S8R2
Version 4.2.0(2)
WAMP 2.0

#2

juggernautsei wrote on Wednesday, May 20, 2015:

I just thought to ask Demi where is it suppose to appear on the claim and she informed me box 23.

#3

visolveemr wrote on Wednesday, May 20, 2015:

Hello Sherwin Gaddis,

To have CLIA number on Box 23, you need to add “BOX 23. Prior Authorization No.” on “Misc Billing Options for HCFA-1500” form under Patient/Client-> Visit forms

Thanks
OpenEMR Customization/Support Team,
ViSolve Inc
services@visolve.com | Phone: 408-850-2243
Demo’s @ ViSolve Demo Library

#4

juggernautsei wrote on Thursday, May 21, 2015:

Thank you for that update. I was having a devil of a time trying to find
this in the Wiki.

#5

fsgl wrote on Friday, May 22, 2015:

In general instructions from the manual & a review of the gen_hcfa_1500 file will give the user a good idea of what goes where.

Misc Billing Options had not been completely updated for CMS 1500 02-12 as explained here & here, in which case there is no choice but to ask for help.

#6

juggernautsei wrote on Wednesday, September 02, 2015:

This is a thorn in the flesh to have to insert the number in box 23 for each and every patient. Has anyone made this a Global setting?

#7

teryhill wrote on Wednesday, September 02, 2015:

Would it work to put the CLIA number in the CLIA number field under facilitys?

Terry

#8

teryhill wrote on Thursday, September 03, 2015:

Tell me what triggers the need for the clia number to be placed in box 23.

Terry

#9

juggernautsei wrote on Thursday, September 03, 2015:

I don’t really understand billing to that level. I am investigating at this point. What I do know is that when the x12 is generated this information is missing .

I have followed the trail to line 1061 of the Claim.class.php file.
I have set a value in globals to hold the CLIA number. I am going to replace
This:
function priorAuth() {
return x12clean(trim($this->billing_options[‘prior_auth_number’]));
}

with this:
(add this at line 255 $this->CLIA_option = $GLOBALS[‘prior_authorization_no’]:wink:

function priorAuth() {
return x12clean(trim($this->CLIA_option));
}

Thoughts anyone…

#10

fsgl wrote on Thursday, September 03, 2015:

Here is a webpage on billing for laboratory services.

#11

teryhill wrote on Thursday, September 03, 2015:

You need to look at about line 641

function cliaCode() {
return x12clean(trim($this->facility[‘domain_identifier’]));
}

Terry

#12

fsgl wrote on Thursday, September 03, 2015:

It appears that there is no provision to grab the CLIA # from Facilities in the gen_hcfa_1500.inc.php. Line 452 only will take the number entered in Misc Billing Options, Box 23.

There will be times when Box 23 will be needed for other prior authorizations. Some insurers will not pay for a service unless they grant permission before the visit.

To allow for greater flexibility, would suggest that a statement be placed in gen_hcfa_1500 file to grab CLIA # from Facilities, if Box 23 in Misc Billing Options is empty. If there is a prior authorization number in Misc Billing Options, that number would populate Box 23 on the CMS 1500 form instead of the CLIA #.

There appears to be a provision for the CLIA # in the gen_x12_837 file.

If cliaCode() is determined by Line 641, what changes are necessary to get the CLIA # to appear in the 837P?

#13

teryhill wrote on Thursday, September 03, 2015:

Just when does the Clia number need to be there. If there are labs or when there is no prior authorization. I just need to know when to throw the switch. I would think it would be WITH LABS and NO PRIOR AUTH. How do I tell if labs are present?

I can fix it I just need to know what triggers the event.

Terry

#14

fsgl wrote on Thursday, September 03, 2015:

It would be rather complicated to check CPT/HCPCS automatically for lab studies.

For offices which have their own lab, it would be safe to assume studies are ordered routinely.

Probably easier to have CLIA # go into Box 23 of the CMS 1500 all of the time for those offices, provided that there is no entry in Misc Billing Options for other authorization numbers. No prior authorization should trigger CLIA # in Box 23.

The problem arises if both CLIA & prior authorization are needed for the same claim. In which case, the office would need to submit 2 paper claims for the same service. Sherwin will have to ask Demi how often this happens.

Like Box 17 life would be simpler to send the 837P because if CLIA # is in Facilities, it should appear in the e-claim independently of prior authorizations. If prior authorization is needed as well, it has its own section in Loop 2300.

#15

juggernautsei wrote on Wednesday, October 07, 2015:

I ended up making a global entry and pulling that global entry. I did not try the box in the facility form. I just saw it yesterday. It could be pulled from there as well.

After reading what fsgl wrote there may need to be a checkbox option to include always.

As for the pain practice that this arose with, they have labs all the time so the CLIA number needs to be on every claim.

#16

fsgl wrote on Wednesday, October 07, 2015:

If the Pain Management Clinic must have CLIA all the time, it may be simpler to have it in Box 23 as a default. See attachment.

There is enough room for the Prior Authorization number on the next line, should both be required. Demi will have to ask the insurers if this is kosher with them before the code change.

Didn’t test the spacing on a CMS 1500, so tweak it.

This way Demi only needs to enter the authorization number when necessary & no fooling about in Globals togling back & forth.

Life is still tidier on the 837P side.

#17

teryhill wrote on Friday, February 19, 2016:

I think I figured this out. Sherwin do you have multiple facilitys?

Terry

#18

@teryhill I am back at this again and yes there are multiple facilities. I made a switch in the code this time to post the clia instead of the prior auth.

#19

The facilities will handle the Clia number and the prior auth can be done on the misc billing form. Not sure it you still have a problem?

#20

It is not so much as a problem but the way the biller would like to handle the claims. She wants the CLI number on every claim. She don’t want to have to go to the Prior Auth form form for every patient and enter it since for this practice it is always the same. It does not change.