Clinical Laboratory Improvement Amendments of 1988 (CLIA) Recertification Procedures

Some CLIA certified providers have experienced claims issues when submitting claims after merging or being acquired by another lab. CLIA recertification in the N.C. Medicaid and N.C. Health Choice (NCHC) programs requires providers to submit the Medicaid provider change form with a copy of the CLIA certificate attached to the form. If a lab is acquired by or merges with another lab, CLIA numbers must be updated so that they match the provider name listed on the provider’s N.C. Medicaid and NCHC files. If the name does not match the CLIA number, the provider’s claim will deny with an Explanation of Benefit (EOB).