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Providers of clinical diagnostic laboratory services,
Ohio Department of Medicaid (ODM) is aware that some claims for clinical diagnostic laboratory services are currently not being paid because system edit 103 has determined that the procedure reported on a detail line is "not an approved service for provider".
This problem is occurring because the Fiscal Intermediary (FI) is attempting to verify the Clinical Laboratory Improvement Amendments (CLIA) certification only of the rendering provider (e.g., individual practitioner) and not of the billing provider (e.g., professional medical group).
Claims with detail lines for clinical diagnostic laboratory services that are affected by edit 103 were in 'pending' status but have been released for processing, at which point payment for the pended details will be paid or denied.
ODM is working with our vendor on a solution to this issue. We will provide updates as they become available.
Please direct any questions about this matter to NONINSTITUTIONAL_POLICY@medicaid.ohio.gov.
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