IHCP updates CLIA procedure codes and mass adjusts/reprocesses claims

Procedure codes associated with laboratory testing are regulated under CLIA. Indiana Health Coverage Programs (IHCP) policy requires compliance with CMS recommendations regarding CLIA regulations under all IHCP programs, whether managed care or fee-for-service (FFS). The IHCP identified inconsistencies in its FFS claims processing system with respect to the classification of certain CPT and HCPCS codes. Effective September 2, 2016, the FFS system will be updated to make specific changes to correct these inconsistencies. FFS claims that denied for explanation of benefits (EOB) 4208 – Invalid CLIA certification/procedure code combination will be mass adjusted or mass reprocessed. Providers should begin seeing adjusted or reprocessed claims on Remittance Advices (RAs) beginning September 20, 2016, with internal control numbers that begin with 56 (mass adjusted) or 80 (mass reprocessed).