MA120 denial code description and corrective action

• This denial occurs when CLIA certification number is required but missing in the claim.

• It may also occur when we use an outdated or wrong CLIA certification number.

Actions

• First, we need to verify the status of the claim. This can be done by checking the status through the insurance web portal or by calling the payer.

• The most important step is to determine whether the claim denial is valid or if the insurance has denied the claim by mistake.

• Call the insurance company and ask the representative to provide the correct CLIA certification number. If the rep provides the correct CLIA certification number and we also billed the claim with the same CLIA certification number, then ask the rep to verify the CLIA certification number present on the claim. If it is found that the claim is billed with the correct one, then ask the representative to reprocess the claim. Be sure to note the claim number, rep name, and call reference number, and then follow up on the claim after the provided TAT.

• If the rep provides the correct CLIA certification number but we billed either the wrong CLIA certification number or missed the CLIA certification number, then we submit a corrected claim with the updated CLIA certification number.

• Medicare does not accept corrected claims, so in the case of any denial, a new claim must always be submitted.

• If the rep does not provide the CLIA certification number, then we can also use portal like CMS and CDC to find CLIA number.

• If we are not able to find the correct CLIA certification number from any resource, then we contact the client for suggestions.

• For submitting an corrected claim, must calculate the timely filing limit starting from the processed date. If the limit has been exceeded, the claim will be denied again for exceeding the filing deadline. In such cases, we should consult with the provider. Some clients may still want us to submit the corrected claim even after the timely filing limit has passed, so we should proceed according to their instructions.

Description