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We have lab denials with UHC and after claim reconsideration they said, “Reviewed request and found the claim was processed with the CLIA id submitted on the corrected claim however the line is denied due to an address mismatch issue. The zip code billed on the claim image does not match the zip code that is listed with the CLIA ID demographics. Line remains denied, no adjustment needed.”
We use the CLIA waiver provided to us by the state.
I have double checked our address with them.
I have double checked the address on the claim.
Has anyone else had this issue? What am I missing? Or how did you resolve it?
Yes I am having that same issue! I am checking into the address on the CLIA certification waiver form-it has the address of Jefferson City. But there is no box to put that address in on the billing website. the drop down box has my address here on it and it will not let me put any other address in there. I have had several denied because of that-nobody will help me. Even when I sent them the CLIA certification they came back and denied my claims.
SO it is not resolve as of yet.
My advice would be to call your UHC provider rep or advocate. Mine is Leslie Kenedy. I had the same issue, only we have our own CLIA waiver here. I went through a lot to get it all fixed. It was a huge headache. I called Leslie Kenedy. She helped me figure it all out. Turns out, our address on our CLIA waiver was not a physical address and it had to be, so we had to get that changed. We also had to get UHC to change our servicing provider address to our physical address, because UHC had our PO Box in there. That was a big ordeal too. Then when the claims were still denied, she found that our CLIA number had never been loaded into UHC’s system. And our NPI was wrong, so we had to clarify all that. All this took numerous phone calls with Leslie and Holly Jarvis (contract manager), as well as lots of emails and a lot of leg work. Also, if you are using UHC’s provider portal (Link), Claim Submission tool, make sure you are putting all the info they require (there is a lot). Good luck! I still have CLIA services unpaid from UHC since this managed care began. I have to go back and correct them to get them paid, hopefully. And yes, UHC is the only managed care company I ever had any problems with.
That is my suggestion also – talk to your rep with UHCCP and/or the credentialing/contracting department. If you cannot get answer or get it resolved, file a complaint with the Medicaid Managed Care Unit 573-526-4274, mhd.mccommunications@dss.mo.gov . They are responsible for making sure the managed care companies pay as they are supposed to. If no one ever files complaints, the unit is unaware or problems with the managed care companies. This seems like a major issue with numerous counties – the managed care unit should probably be involved.
It took a LOT of work, but my UHC claims (CLIA too) are all being paid now, as long as I do everything correctly on the claim. They require a lot of extra info for a CLIA service to be paid. They are very frustrating.
We have our own CLIA waiver for our health department because we do other tests not related to WIC. So I don’t know if that makes difference or not.
The only CLIA waiver we have is the one the state provides. Is this problem not fixable with the state provided CLIA waiver?
yes and if your using a clearing house make sure the CLIA # and the QW modifier is both in as Office Ally was not keeping the ClIA number in and it was disappearing..
Thanks, the QW modifier and CLIA number are on all of these claims. We’ve found that they are denying specifically because the address on the CLIA waiver does not match the facility address on the claim.
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