
Anthem – Clinical Laboratory Improvement Amendments
August 10, 2023
Claim format and elements | CLIA number location options | Referring provider name and NPI number location options | Servicing laboratory physical location |
HIPAA 5010 837 Professional | Must be represented in the 2300 loop, REF02 element, with qualifier of X4 in REF01 | Submit the referring provider name and NPI number in the 2310A loop, NM1 segment. | Physical address of servicing provider must be represented in the 2310C loop if not equal to the billing provider address and must match the address associated with the CLIA ID submitted in the 2300 loop, REF02. |
Source: https://providernews.anthem.com/wisconsin/articles/clinical-laboratory-improvement-amendments-6