MedicaidDocumentationHigh impact
Provider Reminder - CLIA Certificate Editing
Aetna Better Health of Virginia·VA·Policy Update
We identified it
Aug 13, 2026
Summary
Aetna Better Health of Virginia is reminding providers that laboratory claims must include valid and active CLIA certificate numbers in the correct claim submission locations to avoid denials. Providers receiving CARC/RARC 16/MA120 denials must verify CLIA numbers are properly submitted: on electronic claims in Loop 2300 (REF01=X4, REF02) or on paper CMS 1500 forms in Field 23, with hyphens or semicolons separating multiple items.
Action Required
Immediately: Billing team must audit all active laboratory claims to ensure CLIA certificate numbers are submitted in the correct locations per claim type. For electronic claims, verify Loop 2300 REF01=X4 contains the valid CLIA number. For paper CMS 1500 claims, verify Field 23 contains the CLIA number with proper separators (hyphen or semicolon) if multiple items are listed. Update claim submission protocols and billing software validation rules to mandate CLIA number inclusion before transmission. Train all billing staff and providers on proper CLIA submission requirements. Any claims denied with CARC/RARC 16/MA120 should be resubmitted with corrected CLIA information. Failure to include valid CLIA numbers will result in claim denials.