Clinical laboratory improvement amendments (CLIA) billing changes

Currently Humana may allow a charge during initial adjudication for lab or pathology without a CLIA number billed on the initial claim, or if a practitioner submits a procedure that is above the performing lab’s CLIA certification. Humana will then request a refund from the practitioner after initial adjudication. Effective June 2015, Humana will deny the services during initial adjudication if no CLIA number is provided or if a procedure exceeds the performing practitioner’s CLIA certification. This change will improve Humana’s ability to process claims correctly during initial adjudication and reduce the need to request a refund from a practitioner.