Read about the Revised Implementation Timeframes of CLIA Certification Data here.
All Providers who perform or bill laboratory services must comply with the Clinical Laboratory Improvement Amendments (CLIA). To meet these requirements, Providers must have an active CLIA certification and may only bill for laboratory services covered under their current certification.
Texas Medicaid will reimburse laboratory services only when:
- The Provider complies with CLIA requirements, and
- The Provider has the appropriate CLIA certification for the procedure code billed.
Please note: Claims submitted without the correct CLIA certification on file will not be reimbursed.
Updating CLIA Information in PEMS:
Providers can update their CLIA information in the Provider Enrollment and Management System (PEMS) using one of the following pathways, depending on enrollment status:
- Disenrolled Providers: Update CLIA information through a PEMS Reenrollment request.
- Enrolled Providers outside the revalidation window: Update through a PEMS Maintenance or Existing Enrollment request.
- Enrolled Providers within the revalidation window: Update through PEMS Revalidation. If a Revalidation application has not yet been submitted, a Maintenance request may also be used. Providers who have already submitted Revalidation cannot submit a Maintenance request.
During Revalidation, CLIA information must be entered on the License/Certification/Accreditation tab in PEMS. Providers may verify their enrollment and revalidation date in the PEMS portal. Revalidation may be completed up to 180 days before its due date.
Additional CLIA Information:
To learn more about CLIA certification types, visit the Types of CLIA Certificates page on the CMS website.
Need Help?
- For assistance, contact the TMHP Contact Center at 800‑925‑9126.
- For questions or assistance in updating your information, please reach out to ProviderEnrollment@hhs.texas.gov.
- For additional questions regarding this new requirement, please review the attached FAQ from HHSC.
Providers are encouraged to share this information with their staff. If you have any questions about this notice, please email Provider Relations at ProviderRelations@cfhp.com or call 210-358-6030. You can also contact your Provider Relations Representative directly.
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