MedicaidDocumentationHigh impact
[Indiana] Clinical Laboratory Improvement Amendments (CLIA) Claims Submission Requirements
CareSource·IN·Provider Bulletin
Effective date
Mar 11, 2026
We identified it
May 9, 2026
Summary
CareSource now requires that all laboratory claims with procedure codes 80000-89999 submitted with Place of Service 11 (Office) must include a valid CLIA number or the claims will be rejected. The CLIA number must be submitted in Box 23 of CMS-1500 forms or in loop 2300, REF02 (where REF01 = X4) for 837 professional EDI claims.
Action Required
Effective immediately: Billing team must update all laboratory claim submission processes to require CLIA number entry before claim submission. For CMS-1500 paper claims, ensure providers enter the valid CLIA number in Box 23 (Prior Authorization Number field). For EDI 837 professional claims, configure billing software to populate the CLIA number in loop 2300, REF02 with REF01 = X4 per X12 TR3 Implementation Guide standards. Audit all office-based laboratory claims (POS 11) with procedure codes 80000-89999 submitted in the past 2 months and resubmit any missing CLIA numbers. Failure to include the CLIA number will result in claim rejection and reimbursement delays.