CurrentMolina HealthcarePolicy N/A

Non-Participating Laboratory COVID Testing - Medicare Members

Governs documentation requirements that non-participating laboratories must submit to Molina Healthcare of California to receive payment for COVID-19 testing performed on Medicare members. Affects non-participating labs billing Molina for Medicare member COVID testing.

Policy Summary

PayerMolina Healthcare

PolicyNon-Participating Laboratory COVID Testing - Medicare Members

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionSubmit CLIA certification including Page 2 showing certification to perform COVID-19 testing; claims will be denied until documents are received.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

1required document type (CLIA certification including page 2)

3submission methods listed (mail, fax, email)

42 CFR § 424.5regulation cited for provider entitlement to payment

42 USC § 263a(b)CLIA statute cited

Payment and Coverage Requirements

Payment and compliance criteria

Claims payment conditions for non-participating laboratories:

Submit CLIA certification including Page 2 demonstrating certification to perform COVID-19 testing

Documents should be sent to Molina via mail, fax, or email as specified

All claims will be denied unless and until the appropriate documents are received

Claims payment will not be processed prior to receipt of documentation

Provider must have been qualified to receive payment at the time services were rendered per 42 CFR § 424.5

Laboratory must hold a current, valid CLIA certificate for the services per 42 USC § 263a(b) and 42 CFR § 493.3(a)

Coding and Documentation Requirements

Policy Summary

PayerMolina Healthcare

PolicyNon-Participating Laboratory COVID Testing - Medicare Members

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionSubmit CLIA certification including Page 2 showing certification to perform COVID-19 testing; claims will be denied until documents are received.

SourceLink

On This Page

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Provider Actions and Regulatory Citations

Documentation Required

Documentation Required for Payment — Non‑participating Labs

Notice: Non-participating laboratories billing Molina Healthcare for Medicare members must provide CLIA certification (including Page 2) that specifically shows certification to perform COVID-19 testing. All claims will be denied unless and until the appropriate documents are received.

Send documents to: Molina Healthcare, Inc. Attn: CLIA Reviewer, 200 Oceangate, Suite 100, Long Beach, CA 90802
Fax: (855) 366-5462 — Attn: CLIA Reviewer
Email: CA_SIU@MolinaHealthcare.com

Note

Payment Entitlement and Regulatory Citations

A provider is entitled to payment for Medicare member claims only if the provider was qualified to receive payment at the time services were rendered (42 CFR § 424.5). Under CLIA, a laboratory may not perform testing on human-derived materials without a valid CLIA certification (42 USC § 263a(b)). HHS regulations require a current CLIA certificate for the services; a laboratory lacking a current CLIA certificate is out of compliance (42 CFR § 493.3(a)). See also Medicare Claims Processing Manual, Chapter 16 - Laboratory Services, §70 regarding CLIA requirements for laboratories soliciting or accepting specimens in interstate commerce.

OpenPayer

Non-Participating Laboratory COVID Testing - Medicare Members

Payment and Coverage Requirements

Coding and Documentation Requirements

Provider Actions and Regulatory Citations

Defined Terms